右美托咪定联合低浓度罗哌卡因硬膜外麻醉在椎间孔镜手术中的应用效果观察  

The effect of Dexmedetomidine combined with low concentration Ropivacaine epidural anesthesia for percutaneous transforaminal endoscopic discectomy

作　　者：田培 普玉菊 解友利[1] TIAN Pei;PU Yuju;XIE Youli(Department of Anesthesiology,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen,Guangdong,518000,China)

机构地区：[1]深圳市中医院麻醉科,广东深圳518000

出　　处：《医药前沿》2023年第12期10-12,共3页Journal of Frontiers of Medicine

摘　　要：目的:观察右美托咪定联合低浓度罗哌卡因硬膜外麻醉用于椎间孔镜下椎间盘切除术的临床效果。方法:选取2018年2月—2021年2月期间深圳市中医院接受经皮椎间孔镜手术的患者100例,随机分为4组:右美托咪定+硬膜外组(A组)、硬膜外组(B组)、右美托咪定+局麻组(C组)和局麻组(D组)各25例。A、B组左侧卧位,选择手术部位上两个间隙行硬膜外穿刺置管,证实无全脊麻后,分别给予0.3%的罗哌卡因5、7、8mL,C、D组患者俯卧位由手术医生在手术部位给予0.5%罗哌卡因局部麻醉,A、C组术前10min微量泵静脉持续泵注右美托咪定0.5μg/(kg·h)至术毕。记录手术期间的心率(HR)、平均动脉压(MAP)、视觉模拟疼痛评分(VAS)、镇静评分和下肢运动神经阻滞情况。结果:A组和B组在T1-T4各时间点HR、MAP低于D组,差异有统计学意义(P<0.05);A、B两组在T1-T4各时间点的VAS评分均明显低于C、D两组,差异有统计学意义(P<0.05);A组和B组VAS评分比较,差异无统计学意义(P>0.05)。镇静程度T1和T4时间点A、C两组Ramsay镇静评分高于B、D两组,A组在T2、T3时间点评分均高于B、C、D三组,差异有统计学意义(P<0.05)。A、B两组患者运动阻滞高于C、D两组,差异有统计学意义(P<0.05)。结论:右美托咪定联合低浓度罗哌卡因硬膜外麻醉在椎间孔镜手术中的应用效果较好。Objective To observe the effects of Dexmedetomidine combined with low concentration Ropivacaine epidural anesthesia for percutaneous transforaminal endoscopic discectomy.Methods One hundred adults patients with lumbar disc herniation undergoing elective percutaneous transforaminal endoscopic discectomy were enrolled between February 2018 and February 2021 in our hospital and they were randomly divided into 4 groups:group A,group B,group C and group D,with 25 cases in each group.group A were continuously given 0.5μg/(kg•h)Dexmedetomidine infusion before epidural ropivacaine at 0.3%,group B received epidural ropivacaine at 0.3%;Group C were continuously given 0.5μg/(kg•h)Dexmedetomidine infusion before local anesthesia;Group D received a local infiltration of the surgical wound with 0.5%Ropivacaine.The epidural anesthesia technique was performed at the intervertebral space above the lumbar disc herniation as puncture site with the patients in the left lateral decubitus position,and an epidural catheter was threaded into the epidural space and secured;Three doses of 5 mL,7 mL and 8 mL Ropivacaine was given as total drug for epidural top up;Intraoperative hemodynamic parameters,visual analogue scale(VAS),ramsay sedation score and legs motor function were investigated.Results The heart rate(HR)and mean arterial pressure(MAP)during surgery was lower in group A and group B than that in group D(P<0.05),the VAS were lower in group A and group B than that in group C and group B(P<0.05),no significant difference of VAS was observed between the group A and group B during surgery(P>0.05).The ramsay sedation scores at T1 and T4 were higher in group A and group C than that in group B and group D(P<0.05),The scores of group A at T2 and T3 were higher than those of group B,C and D(P<0.05).The legs motor function were worse in groups A and B than those in groups C and D(P<0.05).Conclusion Dexmedetomidine combined with low concentration Ropivacaine epidural anesthesia is a better choice for percutaneous transforaminal endosco

关 键 词：罗哌卡因 右美托咪定 硬膜外麻醉 经皮椎间孔镜手术 

分 类 号：R614[医药卫生—麻醉学]