摘要
目的评价右美托咪定辅助腰丛联合坐骨神经阻滞在膝关节镜手术中的效果。方法择期行单侧膝关节镜手术患者50例，ASA分级Ⅰ或Ⅱ级。采用随机数字表法将患者分为对照组和右美托咪定组，每组25例。右美托咪定组静脉输注右美托咪定负荷量0．8μg／kg（注射时间10min），继以0．4μg／（kg·h）维持输注至术毕，对照组同法给予0．9％氯化钠。用药10min后开始神经刺激仪定位下行腰丛联合坐骨神经阻滞，术中麻醉效果欠佳时静脉注射芬太尼50肛g。于麻醉前（T0）、静脉给药即刻（T1）、手术开始即刻（T2）、手术开始后10min（T3）及手术结束时（T4）记录平均动脉压（MAP）、心率、脉搏血氧饱和度（SpO2）、呼吸频率，记录术中不良反应发生情况、芬太尼使用情况及术者满意晴况。结果两组T0MAP、心率比较差异均无统计学意义（P〉0．05）；对照组T2～4MAP、心率较T0明显升高，而且均明显高于右美托咪定组[MAP：（137±18）mmHg（1mmHg=0．133kPa）比（107±14）mmHg、（132±11）mmHg比（107±11）mmHg、（131±13）mmHg比（95±12）mmHg；心率：（99±17）次／min比（88±14）次／min、（99±14）次／min比（81±15）次／min、（97±14）次／min比（76±11）次／min]，差异均有统计学意义（P〈0．05）。两组各时间点呼吸频率和SpO2比较差异均无统计学意义（P〉0．05），但右美托咪定组有2例、对照组有5例出现SpO2下降明显（〈0．90），通过托下颌等处理后很快恢复正常（〉0．97）。右美托咪定组使用芬太尼率和术者满意率明显优于对照组[28％（7／25）比68％（17／25）、100％（25／25）比80％（20／25）]，差异均有统计学意义（P〈0．05）。两组使用阿托品、麻黄碱率及呼吸抑制发生率比较差异均无统计学意义（P〉0．05）。结论右美托咪定用于腰丛联合坐骨神经阻滞下膝关节镜手术的辅助效果确切，不良反应少，术者满意率高。
Objective To evaluate the effect of dexmedetomidine as a supplementary to combined lumbar plexus-sciatic nerve block for arthroscopic knee surgery. Methods Fifty patients who were scheduled for arthroscopic knee surgery and ASA class I or lI grade,were divided into control group and dexmedetomidine group by random digits table method with 25 cases each. The patients of dexmedetomidine group were given loading dose dexmedetomidine 0.8 μ g/kg（injection time 10 min） by intravenous infusion, then were given maintenance dose 0.4 μ g/（kg· h） to the end of operation. The patients of control group were given 0.9% sodium chloride,methods with the dexmedetomidine group. After 10 min,combined lumbar plexus-sciatic nerve block was performed by a nerve stimulator in both groups. Fentanyl 50 μ g was infused intravenously to the patient whose effect of block was inadequately. The mean arterial pressure （MAP）, heart rate （HR）,pulse oxygen saturation （SpO2）,respiratory frequency at preanesthesia （T0）,beginning of dexmedetomidine infusion （T1）, beginning of surgery （T2）, 10 minutes of surgery （T3） and the end of surgery （T4） were recorded, and intraoperative untoward reaction, using of fentanyl and doctor＇ s satisfaction rate were recorded. Results There were no statistical differences in MAP and HR at To between the 2 groups （P 〉 0.05 ）. MAP and HR at T2-4 were significantly higher than those at To in control group, furthermore MAP and HR at T2-4 in control group were significantly higher than those in dexmedetomidine group [ MAP： （ 137 ± 18） mm Hg（1 mm Hg = 0.133 kPa） vs. （107 ± 14） mm Hg, （132 ± 11） mm Hgvs. （107 ± 11） mm Hg, （131 ± 13） mm Hg vs. （95 ± 12） mm Hg;HR： （99 ± 17） times/min vs. （88 ± 14） times/min, （99 ± 14） times/min vs. （81 ± 15） times/min, （97 ± 14） times/min vs. （76 ± 11 ） times/mini,there were statistical differences （P 〈 0.05 ）. There were no statistical differences in respiratory frequency and SpO2 between the 2 groups （P 〉 0.05）,but 2 cases in dexmedetomidine group,5 cases in control group appeared SpO2 〈 0.90,they quickly returned to normal （ 〉 0.97） by holding up the submaxilla. The using rate of fentanyl and doctor＇ s satisfaction rate in dexmedetomidine group were significantly better than those in control group [28%（7/25） vs. 68% （ 17/25 ）, 100% （ 25/25 ） vs. 80% （ 20/25 ） ], there were statistical differences （P 〈 0.05 ）. There were no statistical differences in the using rate of atropine and efedrina, the rate of respiratory depression between the 2 groups （P 〉0.05）. Conclusion Dexmedetomidine as a supplementary to combined lumbar plexus-sciatic nerve block for arthroscopic knee surgery has effect confirmed,low untoward reaction,high doctor＇ s satisfaction rate.
出处
《中国医师进修杂志》
2013年第35期26-29,共4页
Chinese Journal of Postgraduates of Medicine
