摘要
目的探讨右美托咪啶持续泵注辅助硬膜外麻醉在椎间孔镜下髓核摘除术患者中的应用效果,为临床治疗提供依据。方法选取2018年2月至2019年3月在安康市中心医院就诊的腰椎间盘突出患者92例为研究对象。采用随机数表法分为观察组和对照组,每组46例。对照组患者实施硬膜外麻醉,观察组在硬膜外麻醉的基础上持续泵注右美托咪定。比较两组患者在俯卧位麻醉前(T1)、静脉泵注右美托咪定时(T2)、手术切口注入利多卡因时(T3)、术中30 min时(T4)、完成手术时(T5)的平均动脉压(MAP)、收缩压(SBP)、心率(HR)水平,比较两组患者T1~T5的Ramsay镇静评分及疼痛VAS评分,统计不良反应发生率。结果两组患者在T1时的血流动力学、Ramsay镇静评分及疼痛VAS评分比较差异均无统计学意义(P>0.05);观察组患者在T2~T5时的收缩压、舒张压及心率水平明显低于对照组,差异均有统计学意义(P<0.05);两组患者在T2~T5时的Ramsay镇静评分均升高,且观察组[(1.40±0.50)分、(1.90±0.40)分、(1.70±0.50)分、(1.80±0.30)分]明显高于对照组[(1.20±0.10)分、(1.30±0.20)分、(1.40±0.20)分、(1.50±0.30)分],差异均有统计学意义(P<0.05);两组患者在T2~T5时的VAS评分均降低,且观察组[(1.60±0.40)分、(1.80±0.50)分、(1.40±0.30)分、(1.50±0.30)分]明显低于对照组[(2.80±0.70)分、(2.90±0.80)分、(2.60±0.70)分、(2.30±0.60)分],差异均有统计学意义(P<0.05);治疗后,观察组患者的不良反应总发生率为2.17%,明显低于对照组的15.22%,差异有统计学意义(P<0.05)。结论在椎间孔镜下髓核摘除术中对患者实施右美托咪啶辅助硬膜外麻醉效果显著,其不仅能有效缓解患者疼痛,提高镇静作用,稳定患者的血流动力学指标,还能降低不良反应发生率,值得临床推广使用。
Objective To explore the effect of continuous pump injection of dexmedetomidine and epidural anesthesia in patients undergoing nucleus pulposus removal under the intervertebral foramen,and to provide evidence for clinical treatment.Methods A total of 92 patients with lumbar disc herniation,who admitted to Ankang Central Hospital from February 2018 to March 2019,were selected and divided into the observation group and control group by random number table method,with 46 patients in each group.The control group was given epidural anesthesia,and the observation group continued to pump dexmedetomidine on the basis of epidural anesthesia.The mean arterial pressure(MAP),systolic pressure(SBP),and heart rate(HR)of the patients in the two groups were compared before anesthesia in prone position(T1),at the time of intravenous pump injection of right metoclopramide(T2),the time of operation incision injection of lidocaine(T3),the time of operation for 30 minutes(T4),and the time of operation completion(T5).The Ramsay Sedation score and pain VAS score of the patients in the two groups were compared,and the incidence of adverse reactions was counted.Results There was no significant difference in hemodynamics,Ramsay sedation score,and pain VAS score at T1 between the two groups(P>0.05);the systolic blood pressure,diastolic blood pressure,and heart rate of patients in the observation group at T2 to T5 were significantly lower than those in the control group(P<0.05);after treatment,the Ramsay sedation scores increased at T2 to T5,and those in the observation group were(1.40±0.50)points,(1.90±0.40)points,(1.70±0.50)points,(1.80±0.30)points,respectively,which were significantly higher than corresponding(1.20±0.10)points,(1.30±0.20)points,(1.40±0.20)points,(1.50±0.30)points in the control group(all P<0.05);after treatment,the VAS scores of both groups decreased at T2 to T5,and those in the observation group were(1.60±0.40)points,(1.80±0.50)points,(1.40±0.30)points,(1.50±0.30)points,respectively,which were significantly lower than corresponding(2.80±0.70)points,(2.90±0.80)points,(2.60±0.70)points,(2.30±0.60)points in the control group(all P<0.05);after treatment,the total incidence of adverse reactions in the observation group was 2.17%,which was significantly lower than 15.22%in the control group(P<0.05).Conclusion The effect of dexmedetomidine assisted epidural anesthesia is significant in the operation of nucleus pulposus extraction under the intervertebral foramen,which can not only effectively relieve the pain of patients,improve the sedative effect,stabilize the patient’s hemodynamic parameters,and can also reduce the incidence of adverse reactions.It is worthy of clinical promotion.
作者
李玲
肖晖
LI Ling;XIAO Hui(Department of Anesthesiology,Ankang Central Hospital,Ankang 725000,Shaanxi,CHINA)
出处
《海南医学》
CAS
2020年第8期1006-1009,共4页
Hainan Medical Journal
关键词
右美托咪啶
椎间孔镜
髓核摘除术
硬膜外麻醉
不良反应
Dexmedetomidine
Foraminoscopy
Nucleus pulposus removal
Epidural anesthesia
Adverse reactions
