摘要
目的探讨右美托咪定辅助腰丛联合坐骨神经阻滞在老年患者膝关节镜手术中应用的有效性和安全性。方法 选择择期行单侧膝关节镜手术的患者40例,随机分为神经阻滞组（N组,n=20）和右美托咪定辅助神经阻滞组（D组,n=20）。利用神经刺激仪定位行腰丛-坐骨神经阻滞后,D组患者静脉泵注右美托咪定,负荷剂量0.5μg/kg（4μg/m L）,10 min内泵完,并按0.2μg/（kg·h）持续泵注至手术结束前30 min;N组以同样方式输注等容量的0.9%氯化钠溶液。于右美托咪定给药15 min后开始手术。手术开始前,评定神经阻滞麻醉效果;记录麻醉前（T0）、负荷量泵注完毕后（T1）、手术切皮即刻（T2）、手术开始后15 min（T3）、手术开始后30 min（T4）和手术结束时（T5）的平均动脉压（MAP）、心率（HR）和Sp O2;术中记录两组患者手术时间、异丙酚和芬太尼的使用情况及麻醉相关不良事件的发生情况;并记录术者满意度。结果 两组手术开始前,麻醉效果满意度D组为90%,N组为55%（P〈0.05）;术中两组均有心动过缓、呼吸抑制发生,但差异无统计学意义（P〉0.05）。与N组相比,D组患者术中发生低血压、使用异丙酚和芬太尼的例数明显降低,术者满意度明显增高,HR在T1～T4时间点明显下降（P均〈0.05）;与D组相比,N组患者MAP在T3～T5时间点明显下降（P〈0.05）。结论 右美托咪定辅助腰丛联合坐骨神经阻滞麻醉应用于老年患者膝关节镜手术,其麻醉效果更加确切、术者满意度高,且不良反应少,因此可以安全、有效地应用于临床。
Objective To investigate the efficacy and safety of dexmedetomidine assisted lumbar plexus combined with sciatic nerve block on elderly patients undergoing knee arthroscopy. Methods A total of 40 elderly patients, undergoing unilateral knee arthroscopy were randomly allocated to two groups（n=20）： group N（n=20） received lumbar plexus com- bined with sciatic nerve block and group D（n=20） received dexmedetomidine assisted nerve blocks. The nerve blocks were performed guided with nerve stimulator in both groups. After nerve blocks, in group D a loading dose of dexmedetomidine 0.5 μg/kg, diluted into 20 mL normal saline, was infused within 10 minutes and received the same infusion with a constant speed of 0.2 [xg/（kg＇h） untill 30 minutes before the end of surgery; Group N received the infu- sion of normal saline in the same way. Before the start of surgery, nerve block effect was evaluated; then the mean arte- rial pressure （MAP）, heart rate（HR） and pulse oxygen saturation（SpO2） were recorded at each time point as follows： Ere- anesthetic （To）, loading dose ends （T1）, 0 （T2）, 15 （T3） and 30 （T4） min after incision, and the end of surgery （T5）; the surgery time, adverse events of anesthesia, requirement for propofol and fentanyl, and doctor＇s satisfaction during oper- ation were also recorded. Results The anesthesia satisfactory rate of group D Was 90% and 55% in group N before the start of surgery（P〈0.05）. Bradycardia and respiratory depression had happened during the operation, but there was no statistically significant difference（P〉0.05）. Compared with group N, the incidence of hypotension, requirements for propofol and fentanyl were significantly decreased, doctor＇s satisfaction was remarkably elevated, and HR at T1-T4 was significantly decreased in group D（P〈0.05）. Compared with group D, MAP at T3-T5 was significantly decreased in group N（P〈0.05）. Conclusion Dexmedetomidine assisted lumbar plexus combined with sciatic nerve block for anesthesia on elderly patients undergoing knee arthroscopy is effective and safe, which showed more exact anesthesia effect, higher doctor＇s satisfaction and fewer side effects incidences.
出处
《中国现代医生》
2016年第28期117-120,共4页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2014KYB232)
