| 王松,李娟,张华明,等.右美托咪啶复合地佐辛在经皮内镜下腰椎间盘切除术麻醉中的应用[J].安徽医药,2018,22(10):1975-1978. |
| 右美托咪啶复合地佐辛在经皮内镜下腰椎间盘切除术麻醉中的应用 |
| Application of dexmedetomidine combined with dezocine for the percutaneous endoscopic lumbar discectomy |
| 投稿时间：2017-04-25 |
| DOI： |
| 中文关键词: 麻醉,静脉 椎间盘切除术,经皮 右美托咪啶 地佐辛 |
| 英文关键词: Anesthesia,intravenous Diskectomy,percutaneous Dexmedetomidine Dezocine |
| 基金项目: |
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| 中文摘要: |
| 目的 评价监测麻醉下右美托咪啶复合地佐辛在经皮内镜下腰椎间盘切除术(PELD)中应用的效果及安全性。 方法 选择椎间孔镜患者50例,采用随机数字表法将患者分为两组:观察组(D组)和对照组(A组),每组25例。D组于俯卧后经静脉输注右美托咪啶0.6 μg·kg-1·(15 min)-1,随后以0.2 μg·kg-1·h-1持续输注至手术结束；A组给予等容量的生理盐水。所有患者术前10 min单次静脉给予地佐辛0.1 mg·kg-1,手术开始前由术者给予0.375%罗哌卡因局部浸润麻醉。记录俯卧位(T1)、右美托咪啶给药或生理盐水后15 min(T2)、切皮(T3)、椎间孔成形期(T4)、纤维环操作期(T5)、术毕(T6)等时点的心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO2) 、警觉/镇静评分(OAA/S)、疼痛视觉模拟评分(VAS)评分。记录术中躁动、呼吸抑制及心动过缓的例数,手术结束时统计局麻药用量,分别评定患者和术者对麻醉满意度。 结果 与A组比较,D组术中血流动力学平稳[T3:(75.4±9.1)mmHg比(99.3±9.8)mmHg、T4:(80.6±7.8)mmHg比(95.3±8.7)mmHg、T5:(78.2±7.4)mmHg比(94.2±8.2)mmHg,P＜0.05],OAA/S评分高[T2:(3.58±0.67)比(1.00±0.00)、T3:(3.32±0.79)比(1.45±0.30)、T4:(3.45±0.60)比(1.25±0.35) T5:(3.05±0.71)比(1.11±0.41)、T6:(3.12±0.61)比(1.20±0.52),P＜0.05],同时在T3[(1.51±0.60)比(3.60±1.10),P＜0.05]、T4[(1.60±0.72)比(3.17±1.20),P＜0.05]点VAS评分明显较低,术中局麻药用量也明显减少[(7.8±1.9)比(11.2±1.3) mL,P＜0.05],而两组在配合度上无明显差异。两组均未出现明显的麻醉并发症。 结论 右美托咪啶复合地佐辛用于监测麻醉下PELD手术可获得良好的镇静及镇痛效果,且不增加手术风险。 |
| 英文摘要: |
| Objective To evaluate the effect and safety of dexmedetomidine combined with dezocine for the monitored anesthesia care of percutaneous endoscopic lumbar discectomy (PELD). Methods Fifty patients undergoing percutaneous transformational endoscopic discectomy were randomly assigned into 2 groups,the observation group (group D) and the control group (group A),25 cases in each group.Dexmedetomidine 0.6 μg·kg-1 was injected intravenously over 15 min after the patients were in prone position,followed by infusion at 0.2 μg·kg-1·h-1 until the end of operation in group D,while the equal volume of normal saline was given in group A.All patients were given dezocine (0.1 mg·kg-1) injection 10 min before surgery and local anesthesia by 0.375% ropivacaine.At prone position (T1),15 min after the administration of dexmedetomidine or saline (T2),skin incision (T3),lumbar foraminoplasty (T4),annulus fibrosus operation (T5),the end of surgery (T6) the heart rate (HR),mean arterial pressure (MAP),pulse oxygen saturation (SpO2),observer′s assessment of alertness/sedation (OAA/S) and visual analogue scale (VAS) were monitored and recorded.The number of cases with restlessness,respiratory depression and bradycardia,the total local anesthetics used and the satisfactory degrees of patients and surgeons were recorded. Results In comparison with group A,in group Dthe hemodynamics was stable[T3:(75.4±9.1)mmHg vs. (99.3±9.8)mmHg;T4:(80.6±7.8)mmHg vs. (95.3±8.7)mmHg;T5:(78.2±7.4)mmHg vs. (94.2±8.2)mmHg,P＜0.05],OAA/S scores were significantly higher[T2:(3.58±0.67)vs. (1.00±0.00);T3:(3.32±0.79)vs. (1.45±0.30);T4:(3.45±0.60)vs. (1.25±0.35);T5:(3.05±0.71)vs. (1.11±0.41);T6:(3.12±0.61)vs. (1.20±0.52),P＜0.05],meanwhile,the VAS scores were significantly lower at T3[(1.51±0.60)vs. (3.60±1.10),P＜0.05] and T4[(1.60±0.72)vs. (3.17±1.20),P＜0.05],and the total local anesthetics requirement was significantly fewer[(7.8±1.9)vs.(11.2±1.3) mL,P＜0.05].There were no significent differences in compatibility and anesthesia related complications between the two groups. Conclusion Dexmedetomidine combined with dezocine can provide better sedation and analgesia in the monitored anesthesia care of PELD with no increase in surgical risk. |
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