右美托咪定联合地佐辛在老年患者经皮椎体后凸成形术中的应用  

Application of dexmedetomidine combined with dezocine in percutaneous kyphoplasty in elderly patients

作　　者：孙梅[1] 顾仕贤[1] 王庆宝[1] 曾嵘[1] 毛菇[1] 龚晓毅[1] 郭冬冬 陶莹 陶秀婷 SUN Mei;GU Shixian;WANG Qingbao;ZENG Rrong;MAO Gu;GONG Xiaoyi;GUO Dongdong;TAO Ying;TAO Xiuting(Department of Anesthesiology,Nanjing Jiangbei People’s Hospital,Nanjing 210048,China)

机构地区：[1]南京江北人民医院麻醉科,江苏省南京市210048

出　　处：《组织工程与重建外科》2021年第4期348-351,共4页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的观察右美托咪定(Dex)联合地佐辛在老年患者经皮椎体后凸成形术(PKP)中的应用效果。方法选取2019年1月至2020年8月,在我院接受择期PKP手术的老年患者(65~82岁)40例,随机分为以下两组。Dex(D1)组:静脉给予Dex,0.4μg/kg,10 min泵注完毕,然后患者改为俯卧位,以Dex 0.2μg/(kg·h)维持麻醉至术毕;Dex+地佐辛(D2)组,静脉给予Dex,0.4μg/kg,10 min泵注完毕,然后患者改为俯卧位,静脉注射地佐辛0.05 mg/kg,并以Dex 0.2μg/(kg·h)维持麻醉至术毕。两组均行局部浸润麻醉。观察给药前(T0)、给药后10 min(T1)、穿刺针进针时(T2)、球囊扩张时(T3)、注入骨水泥时(T4)、关闭皮肤时(T5)的平均动脉压(MAP)、心率(HR)、SpO_(2)、VAS评分、Ramsay评分,记录术中不良反应。结果两组患者在T2、T4、T5时的MAP、HR、VAS评分、Ramsay评分差异显著(P<0.05),其他时间则无显著差异(P>0.05);T0~T5时两组患者的SpO_(2)无显著差异(P>0.05);D2组的不良反应发生率10.00%,低于D1的40.00%(P<0.05)。结论在老年患者PKP术中应用Dex联合地佐辛,可强化局部麻醉效果,且具有良好的镇静作用,可有效控制应激反应;联合用药可有效减低Dex的副作用,使血流动力学更加稳定,安全性更高。Objective To observe the effect of dexmedetomidine(Dex)combined with dezocine in percutaneous vertebra kyphoplasty(PKP)in elderly patients.Methods From January 2019 to August 2020,40 elderly patients(aged 65-82 years)undergoing PKP in our hospital were selected and randomly divided into two groups.Dex(D1)group took intravenous pumping of 0.4μg/kg Dex for 10 min and then 0.2μg/(kg·h)Dex prone position;Dex+Dezocine(D2)group took intravenous pumping of 0.4μg/kg Dex for 10 min and then intravenous injection of 0.05 mg/kg dezocine and 0.2μg/(kg·h)Dex prone position.The local infiltration anesthesia was performed.Mean arterial pressure(MAP),heart rate(HR),SpO_(2),VAS score and Ramsay score before medication(T0),10 min after medication(T1),at needle insertion(T2),balloon dilation(T3),bone cement injection(T4),and skin closure(T5)were recorded.Adverse reactions were recorded.Results At T2,T4 and T5,there were significant differences in MAP,HR,VAS scores and Ramsay scores between the two groups(P<0.05),while there were no significant differences at other time points(P>0.05).SpO_(2) of the two groups showed no significant difference at T0-T5(P>0.05).Adverse event rate in D2 group(10.00%)was significantly lower than that in D1 group(40.00%,P<0.05).Conclusion Dex combined with dezocine can enhance the effect of local anesthesia in elderly patients during PKP surgery,and has a good sedative effect,which can effectively control the stress response.Combined drug use can reduce the side effects of Dex,get more stable hemodynamics,higher safety,and is worthy of clinical promotion.

关 键 词：经皮椎体后凸成形术 右美托咪定 地佐辛 老年患者 

分 类 号：R614.24[医药卫生—麻醉学]