辅助镇静联合超声引导下腰俞穴麻醉在肛肠疾病手术中的应用  

Application of Assisted Sedation Combined with Ultrasound-guided Yaoshu Point Anesthesia in Surgery for Anorectal Diseases

作　　者：陈丽丽[1] 牟海萍[1] 王大亮 CHEN Li-li;MU Hai-ping;WANG Da-liang(Huaiyin People's Hospital,Jinan,Shandong 250021)

机构地区：[1]济南市槐荫人民医院,山东济南250021

出　　处：《中国肛肠病杂志》2022年第8期19-22,共4页Chinese Journal of Coloproctology

摘　　要：目的:评价辅助镇静联合超声引导下腰俞穴麻醉在肛肠疾病手术中的应用。方法:选择2021年1~5月拟于我院择期行肛肠手术且采用超声引导下腰俞穴麻醉的600例患者为研究对象,随机分成3组,即右美托咪定组(D组)、咪达唑仑组(M组)和生理盐水组(N组)。超声引导下腰俞穴麻醉前15min,D组予右美托咪定注射液0.5μg/kg静脉泵注(定时15min),M组予咪达唑仑注射液0.03 mg/kg静脉推注,N组予0.9%氯化钠注射液2 mL静脉推注。记录3组患者麻醉前(T_(0))、术前(辅助用药后,T_(1))、术中(直肠牵拉反应时,T_(2))、术毕时(T_(3))的心率(HR)、平均动脉压(MAP)和血氧饱和度(SpO_(2)),以及整体麻醉效果、镇静效果、术中牵拉反应情况和不良反应,并进行对比分析。结果:1)HR、MAP和SpO_(2):3组患者T_(0)~T_(3)时刻HR、MAP、SpO_(2)均在正常范围内。T_(1)和T_(2)时,D组和M组HR、MAP均低于N组(P <0.05);D组、M组相比,除T_(1)时D组MAP低于M组(P <0.05),T_(1)时HR及T_(2)时HR、MAP 2组间差异均无统计学意义(P>0.05)。T_(3)时,D组MAP低于M组和N组(P <0.05),M组与N组MAP差异无统计学意义(P>0.05);D组和M组HR均低于N组(P <0.05),D组低于M组(P <0.05)。2)整体麻醉效果:D组和M组整体麻醉效果优于N组(P <0.05),D组和M组无明显差异(P>0.05)。3)镇静效果:D组和M组镇静效果优于N组(P <0.05),D组优于M组(P <0.05)。4)术中牵拉反应:D组、M组和N组分别有92.5%、76.5%、54.5%的患者术中未出现牵拉反应,组间比较差异均有统计学意义(P <0.05)。5)不良反应:3组比较差异均无统计学意义(P>0.05)。结论:辅助镇静联合超声引导下腰俞穴麻醉安全可行,而且可有效提高麻醉效果,增强镇静效果,抑制牵拉反应。Objective To evaluate the application of assisted sedation combined with ultrasound-guided Yaoshu point anesthesia in anorectal disease surgery.Methods From January to May 2021,600 patients who were scheduled to undergo anorectal surgery in authors’ hospital and were anesthetized at Yaoshu point under the guidance of ultrasound were selected as the study subjects.They were randomly divided into three groups:Dexmedetomidine group(group D),Midazolam group(group M) and normal saline group(group N).At 15 min before anesthesia,group D was given 0.5 μg/kg of Dexmedetomidine injection(intravenous pump injection,timing 15 min),group M was given 0.03 mg/kg of Midazolam injection intravenously,and group N was given 2 mL of 0.9% sodium chloride injection intravenously.The heart rate(HR),mean arterial pressure(MAP) and blood oxygen saturation(SpO_(2)) of the three groups’ patients before anesthesia(T_(0)),before operation(after auxiliary medication,T_(1)),amidst operation(when rectal traction reaction,T_(2)) and at the end of operation(T_(3)),as well as the overall anesthesia effect,sedation effect,traction reaction during operation and adverse reactions were recorded and compared.Results 1)HR,MAP and SpO_(2):the HR,MAP and SpO_(2) of the three groups were within the normal range from T_(0) to T_(3).At T_(1) and T_(2),HR and MAP of group D and M were lower than those of group N(P<0.05);Compared with group D and group M,except that the MAP of group D was all lower than that of group M at T_(1)(P<0.05),there was no significant difference in HR at T_(1) and HR and MAP at T_(2)(P>0.05).At T_(3),the MAP of group D was lower than that of group M and group N(P<0.05),and there was no significant difference between group M and group N(P>0.05);The HR of group D and M was lower than that of group N(P<0.05),and that of group D was lower than that of group M(P<0.05).2) Overall anesthetic effect:the overall anesthetic effect of group D and M was all better than that of group N(P<0.05),and there was no significant difference between g

关 键 词：肛肠疾病 手术 腰俞穴麻醉 辅助镇静 右美托咪定 咪达唑仑 效果 

分 类 号：R614[医药卫生—麻醉学]