摘要
目的探讨右旋美托咪定用于椎管内麻醉下经皮肾穿刺碎石术患者的临床效果和安全有效剂量。方法选择ASAⅠ～Ⅱ级拟在椎管内麻醉下择期行PCNL术患者40例,随机分为4组(D0、D1、D2、D4),每组各10例。D1、D2、D4组手术开始即刻静脉泵注入DEX 1.0μg/kg的负荷剂量,10min输注完毕,而后分别以0.1μg/(kg·h)、0.2μg/(kg·h)、0.4μg/(kg·h)持续静脉泵注至手术结束,D0以生理盐水10ml/h静脉泵注至手术结束。记录每组患者相关各时点HR、MAP、SpO2值及警觉/镇静(OAA/S)评分,呼吸抑制,严重心动过缓,围麻醉期寒战、恶心呕吐等不良反应的发生情况。结果 T1与T2时刻组内比较D1、D2、D4组HR值、OAA/S评分均存在明显下降(P<0.05);Ta与Tb时刻组内比较OAA/S评分在D2、D4组明显提高(P<0.05)。T3～T6时刻各实验组之间比较:与D1组比较,D2组HR值在T5～T6,OAA/S评分在T3～T6存在明显差异,D4组HR值及OAA/S评分在T3～T6,均存在明显差异;与D2组比较,D4组HR值及OAA/S评分在T5～T6,存在明显差异(P<0.05)。结论右旋美托咪定持续泵注用于椎管内麻醉下经皮肾穿刺碎石术能够提供良好的镇静、抗焦虑效应,维持血流动力学稳定,适度减慢心率,可减少围麻醉期寒战、恶心呕吐等不良反应的发生。合理用法推荐为手术开始即刻静脉泵注入DEX 1.0μg/kg的负荷剂量,10min输注完毕,而后以0.2μg/(kg·h)持续静脉泵注至手术结束。
Objective To investigate the clinical efficacy and effective dose of dexmedetomidine sedation in patients undergoing per- cutaneous nephrolithotomy with spinal anesthesia. Methods Fourty ASA Ⅰ - Ⅱ patients scheduled for percutaneous nephrolithotomy un- der spinal anesthesia were randomly allocated to four groups（ D0 ,D1 ,D2, D4 ） , with 10 patients in each group. Before operation,Patients in group D1 ,Dz , D4 ,received DEX 1.0μg/kg within 10min ,then 0.1 μg/（ kg·h） ,0.2μ g/（ kg·h） ,0.4μg/（ kg·h） , infusion until the end of surgery, respectively, while group DO were administered normal saline 10ml/h. HR,MAP,SpO2, OAA / S at the recorded time points, as well as adverse events such as respiratory depression, severe brady cardia, perioperative shivering were assessed. Results When T1 compared with T2in each group, HR and OAA/S scores were signifieantly decreased （P 〈 0.05 ）. When Ta compared with Tb in each group, OAA/S scores were significantly increased in group D2 , D4 （ P 〈 0.05 ）. Compared to group D0 , group D2 and D4 had signifi- cantly difference in HR and OAA / S scores between T3 and T6. Compared to group D2 , group D4 had significantly differenee in SpO2 and OAA / S seores at the same time. Conclusion Perioperative dexmedetomidine infusion ean provide sedative, antianxiety effect in pa- tients undergoing percutaneous nephrolithotomy, with stable hemodynamics and decreased incidence of shivering. The most reasonable dose regimen is loading dose 1.0μg/kg, followed by an infusion rate 0.2μg/（ kg ·h）.
出处
《医学研究杂志》
2012年第12期159-162,共4页
Journal of Medical Research
