BIS指导下酮咯酸氨丁三醇联合右美托咪定监测麻醉在老年PVP手术中的应用  

Application of Ketorolac tromethamine combined with Dexmedetomidine anesthesia under the guidance of BIS in elderly patients undergoing PVP surgery

作　　者：齐超 吴慧红 刘晓东 QI Chao;WU Huihong;LIU Xiaodong(Department of Anesthesiology, Beichen Hospital, Tianjin 300400, China)

机构地区：[1]天津市北辰区北辰医院麻醉科,300400

出　　处：《中国老年保健医学》2020年第3期30-33,共4页Chinese Journal of Geriatric Care

摘　　要：目的探讨BIS指导下酮咯酸氨丁三醇联合右美托咪定监测麻醉在老年患者PVP手术中的有效性和安全性。方法选择2018年11月至2019年11月单个椎体压缩性骨折患者择期行经皮椎体成形术患者120例,男性59例,女性61例,年龄64~79岁,ASAⅡ~Ⅲ级,随机分为局部麻醉组(L组),右美托咪定组(D组)和右美托咪定联合酮咯酸氨丁三醇(DK组),每组40例。DK组酮咯酸氨丁三醇60mg莫非氏管滴注后,右美托咪定初始负荷剂量0.6μg/kg静脉泵注10分钟,维持量为0.3μg/(kg·h),输注速度应保持患者BIS值70~85;D组给予生理盐水2ml后,右美托咪定泵注同D组;L组给予生理盐水2ml后,泵注生理盐水。患者俯卧位,三组手术开始前以1%利多卡因行局部浸润麻醉。记录患者局麻药和血管活性药追加例数以及患者呻吟体动、恶心呕吐、反流误吸、呼吸抑制、呼吸道梗阻等不良反应发生情况患者。入室5分钟后(T0)、俯卧位后即刻(T1)、注入局麻药时(T2)、穿刺针到达椎体时(T3)、骨水泥注入时(T4)、平卧位后即刻(T5)的疼痛VAS评分。结果L组乌拉地尔、艾司洛尔追加例数和局麻药追加例数明显多于D组和DK组(P<0.05),D组乌拉地尔、艾司洛尔追加例数和局麻药追加例数大于DK组(P<0.05),三组其余用药无差异(P>0.05)。T1~T5时L组VAS评分明显高于D组和DK组(P<0.05),T1~T5时DK组VAS评分低于D组,差异均有统计学意义(P<0.05)。L组因为疼痛、不适引起的呻吟体动发生率大于D组和DK组(P<0.05)。三组均未发生恶心呕吐和反流误吸。结论酮咯酸氨丁三醇60mg莫非氏管滴注联合右美托咪定泵注,保持BIS值于70~85,可以提高老年患者俯卧位的PVP手术的安全性和舒适性。Objective To investigate the efficacy and safety of Ketorolac tromethamine combined with Dexmedetomidine under BIS guidance in elderly patients undergoing PVP surgery.Methods From November 2018 to November 2019,120 patients(male 59,female 61,age 64~79,ASAⅡ~Ⅲ)with single vertebral compression fracture underwent elective percutaneous vertebroplasty were randomly divided into local anesthesia group L,dexmedetomidine Group D and dexmedetomidine combined with Ketorolac tromethamine DK group,40 cases in each group.In Dk Group,Ketorolac Trometamol 60mg was infused with mofeys tube,the initial loading dose of Dexmedetomidine was 0.6μg/kg for 10min,the maintenance dose was 0.3μg/(kg·h).The rate of infusion should be maintained at the BIS value of 70~85.Group D was given 2 ml normal saline,then dexmedetomidine was pumped with Group D.Group L was given 2 ml normal saline and then pumped with normal saline.Patients in prone position were anesthetized with 1%lidocaine before operation.The number of additional cases of local anesthetic and vasoactive agent and the incidence of adverse reactions such as moans,nausea and vomiting,aspiration by mistake,inhibition of inhalation and obstruction of inhalation were recorded.Visual analogue scale(VAS)scores of pain at 5 Min after admission(T0),immediately after prone position(T1),at injection of local anesthetic(T2),at arrival of puncture needle(T3),at injection of bone cement(T4)and at recumbent position(T5).Results The number of additional cases of urapidil,esmolol and local anesthetic in group L was significantly higher than that in Group D and DK(P<0.05).The number of additional cases of urapidil,esmolol and local anesthetic in Group D was higher than that in Group DK(P<0.05),there was no difference in the other three groups(P>0.05).The Vas scores of l group were significantly higher than those of D Group and DK group at T1~T5(P<0.05),and the Vas scores of DK group were significantly lower than those of d group at T1~T5(P<0.05).The incidence of moans and body movements in g

关 键 词：脑电双频指数 右美托咪定 酮咯酸氨丁三醇 经皮椎体成形术 

分 类 号：R61[医药卫生—外科学]