不同负荷剂量右美托咪定辅助低位硬膜外麻醉应用于骨科下肢手术效果观察
|
摘要
目的:探讨分析不同负荷剂量右美托咪定辅助低位硬膜外麻醉应用于骨科下肢手术效果。方法:选取2014年2月至2017年8月本院120例行骨科下肢手术患者随机分为A、B、C、D四组,均采用右美托咪定辅助低位硬膜外麻醉,A组患者泵入0.4μg/kg右美托咪定溶液,B组患者泵入0.6μg/kg右美托咪定溶液,C组患者泵入0.8μg/kg右美托咪定溶液,D组患者泵入生理盐水,比较四组患者T0(泵入右美托咪定开始时)、T1(泵入右美托咪定后10 min)、T2(泵入右美托咪定后30 min)、T3(泵入右美托咪定后60 min)、T4(泵入右美托咪定后120 min)平均动脉压、心率、Ramsay镇静评分及不良反应发生情况。结果:T0时四组患者Ramsay镇静评分差异无统计学意义(P>0.05);T1、T2、T3、T4时四组患者Ramsay镇静评分差异具有统计学意义(P<0.05),且C组患者评分高于A、B、D组患者,B组患者评分高于A、D组患者,A组患者评分高于D组患者,差异均具有统计学意义(P<0.05);T0时四组患者HR、MAP差异无统计学意义(P>0.05);T1、T2、T3、T4时A、B、C组患者HR、MAP显著低于D组患者,差异具有统计学意义(P<0.05);T1、T2、T3、T4时A[此处应断句]、B、C组患者组间HR、MAP差异无统计学意义(P>0.05)。四组患者均未出现呼吸抑制,B组1例患者出现窦性心动过缓,C组5例出现窦性心动过缓,发生率显著高于A、B、D组患者,同时C组4例出现低血压,发生率显著高于A、B、D组患者,差异均具有统计学意义(P<0.05)。结论:右美托咪定辅助低位硬膜外应用于骨科下肢手术时,泵入负荷剂量为0.6μg/kg右美托咪定镇静效果更优,且安全性高,值得推广。
Objective: To investigate and analyze the effect of different loading doses of dexmedetomidine in epidural anesthesia in orthopedic lower limb surgery. Methods: 120 patients undergoing orthopedic lower limb surgery in our hospital from February 2014 to August 2017 were randomly divided into group A,group B,group C and group D,all of whom received dexmedetomidine under low epidural anesthesia. Patients in group A were pumped 0. 4 μ g/kg dexmedetomidine solution. Patients in group B were pumped 0. 6 μ g/kg dexmedetomidine solution,and patients in group C were pumped 0. 6 μ g/kg dexmedetomidine solution. 8μ g/kg dexmedetomidine solution. Patients in group D were pumped with normal saline. The average arterial pressure,heart rate,Ramsay sedation score and adverse reactions of four groups of patients T0( at the begin ning of pumping dexmedetomidine),T1(10 min after pumping dexmedetomidine),T2(30 min after pumping dexmedetomidine),T3(60 min after pumping dexmedetomidine),T4(120 min after pumping dexmedetomidine) were compared. Results: there was no statistically significant difference in Ramsay sedation scores among the four groups at t0( P > 0. 05). Ramsay sedation scores of the four groups of patients at t1,T2,T3 and T4 were significantly different( P < 0. 05),and the scores of patients in group C were higher than those in groups A,B and D,the scores of patients in group B were higher than those in groups A and D,and the scores of patients in group A were higher than those in group D. The difference was statistically significant( P 0. 05). There was no significant difference in HR and map between the four groups at t0(P > 0. 05). HR and map of patients in groups A,B and C were significantly lower than those in group D at t1,T2,T3 and T4. The difference was statistically significant( P < 0. 05). There was no significant difference in HR and map between group A,B and C at t1,T2,T3 and T4( P > 0. 05). No respiratory depression occurred in the four groups. 1 patient in group B had sinus bradycardia,and 5 patients in group C had sinus bradycardia. The incidence rate was significantly higher than that of patients in groups A,B,and D. At the same time,there were 4 cases of hypotension in group C,the incidence was significantly higher than that in groups A,B and D and the difference was statistically significant( P < 0. 05). Conclusion: Dexmedetomidine has better sedative effect when it is used in orthopedic lower limb surgery with a loading dose of 0. 6 μ g/kg.And It is worth popularizing.
Objective: To investigate and analyze the effect of different loading doses of dexmedetomidine in epidural anesthesia in orthopedic lower limb surgery. Methods: 120 patients undergoing orthopedic lower limb surgery in our hospital from February 2014 to August 2017 were randomly divided into group A,group B,group C and group D,all of whom received dexmedetomidine under low epidural anesthesia. Patients in group A were pumped 0. 4 μ g/kg dexmedetomidine solution. Patients in group B were pumped 0. 6 μ g/kg dexmedetomidine solution,and patients in group C were pumped 0. 6 μ g/kg dexmedetomidine solution. 8μ g/kg dexmedetomidine solution. Patients in group D were pumped with normal saline. The average arterial pressure,heart rate,Ramsay sedation score and adverse reactions of four groups of patients T0( at the begin ning of pumping dexmedetomidine),T1(10 min after pumping dexmedetomidine),T2(30 min after pumping dexmedetomidine),T3(60 min after pumping dexmedetomidine),T4(120 min after pumping dexmedetomidine) were compared. Results: there was no statistically significant difference in Ramsay sedation scores among the four groups at t0( P > 0. 05). Ramsay sedation scores of the four groups of patients at t1,T2,T3 and T4 were significantly different( P < 0. 05),and the scores of patients in group C were higher than those in groups A,B and D,the scores of patients in group B were higher than those in groups A and D,and the scores of patients in group A were higher than those in group D. The difference was statistically significant( P 0. 05). There was no significant difference in HR and map between the four groups at t0(P > 0. 05). HR and map of patients in groups A,B and C were significantly lower than those in group D at t1,T2,T3 and T4. The difference was statistically significant( P < 0. 05). There was no significant difference in HR and map between group A,B and C at t1,T2,T3 and T4( P > 0. 05). No respiratory depression occurred in the four groups. 1 patient in group B had sinus bradycardia,and 5 patients in group C had sinus bradycardia. The incidence rate was significantly higher than that of patients in groups A,B,and D. At the same time,there were 4 cases of hypotension in group C,the incidence was significantly higher than that in groups A,B and D and the difference was statistically significant( P < 0. 05). Conclusion: Dexmedetomidine has better sedative effect when it is used in orthopedic lower limb surgery with a loading dose of 0. 6 μ g/kg.And It is worth popularizing.
引文
[1]乔孝武,翟易朦,董铁立.右美托咪定在骨科下肢手术中的应用观察[J].河南外科学杂志,2014,20(5):73-74.
[2]Bajwa SJ,Bajwa SK,Kaur J,et al.Dexmedetomidine and clonidine in epidural anaesthesia:A comparative evaluation[J].Indian J Anaesth,2011,55(2):116-121.
[3]黄芳,王俊,杨新静,等.右美托咪定在老年患者外科术后机械通气中的镇静效果分析[J].中华医学杂志,2014,94(41):3211-3215.
[4]陈敏,汤丰宁,王湘江,等.右美托咪定在低位硬膜外神经阻滞中的镇静效果及安全性[J].现代医药卫生,2015,31(5):713-715.
[5]Shaikh SI,Mahesh SB.The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries[J].J Anaesthesiol Clin Pharmacol,2016,32(2):203.
[6]陈愉,万锐杰,郭波,等.右美托咪定对骨科下肢手术患者止血带诱发炎症的影响及机制研究[J].检验医学与临床,2016,13(15):2144-2145.
[7]Solanki SL,Bharti N,Batra YK,et al.The analgesic effect of intrathecal dexmedetomidine or clonidine,with bupivacaine,in trauma patients undergoing lower limb surgery:a randomised,double-blind study[J].Anaesth Intensive Care,2013,41(1):51-56.
[8]Kaur S,Attri JP,Kaur G,et al.Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries[J].Saudi J Anaesth,2014,8(4):463-469.
[9]阮军峰.探讨不同剂量右美托咪定辅助低位硬膜外麻醉在骨科下肢手术的临床效果[J].临床医药文献杂志,2017,65(1):2815-2816.
[10]徐芹,金宇鸿.不同剂量右美托咪定辅助低位硬膜外麻醉在骨科下肢手术的临床作用探讨[J].世界最新医学信息文摘,2018,18(5):129-130.
[11]仲勇,袁岚,周嘉,等.不同剂量右美托咪定辅助低位硬膜外麻醉在骨科下肢手术的临床效果[J].临床和实验医学杂志,2016,15(24):2423.
[2]Bajwa SJ,Bajwa SK,Kaur J,et al.Dexmedetomidine and clonidine in epidural anaesthesia:A comparative evaluation[J].Indian J Anaesth,2011,55(2):116-121.
[3]黄芳,王俊,杨新静,等.右美托咪定在老年患者外科术后机械通气中的镇静效果分析[J].中华医学杂志,2014,94(41):3211-3215.
[4]陈敏,汤丰宁,王湘江,等.右美托咪定在低位硬膜外神经阻滞中的镇静效果及安全性[J].现代医药卫生,2015,31(5):713-715.
[5]Shaikh SI,Mahesh SB.The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries[J].J Anaesthesiol Clin Pharmacol,2016,32(2):203.
[6]陈愉,万锐杰,郭波,等.右美托咪定对骨科下肢手术患者止血带诱发炎症的影响及机制研究[J].检验医学与临床,2016,13(15):2144-2145.
[7]Solanki SL,Bharti N,Batra YK,et al.The analgesic effect of intrathecal dexmedetomidine or clonidine,with bupivacaine,in trauma patients undergoing lower limb surgery:a randomised,double-blind study[J].Anaesth Intensive Care,2013,41(1):51-56.
[8]Kaur S,Attri JP,Kaur G,et al.Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries[J].Saudi J Anaesth,2014,8(4):463-469.
[9]阮军峰.探讨不同剂量右美托咪定辅助低位硬膜外麻醉在骨科下肢手术的临床效果[J].临床医药文献杂志,2017,65(1):2815-2816.
[10]徐芹,金宇鸿.不同剂量右美托咪定辅助低位硬膜外麻醉在骨科下肢手术的临床作用探讨[J].世界最新医学信息文摘,2018,18(5):129-130.
[11]仲勇,袁岚,周嘉,等.不同剂量右美托咪定辅助低位硬膜外麻醉在骨科下肢手术的临床效果[J].临床和实验医学杂志,2016,15(24):2423.