右美托咪定镇静联合不同浓度罗哌卡因在PELD术中的应用
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摘要
目的:探索右美托咪定镇静联合不同浓度罗哌卡因硬膜外麻醉在经皮内窥镜下腰椎间盘切除术(percutaneous endoscopy lumbar discectomy,PELD)中的最佳有效浓度。方法:选择择期行PELD患者120例随机分为3组,每组40例,分别给予不同浓度罗哌卡因,A组0. 25%、B组0. 375%、C组0. 5%。各组均持续静脉泵注右美托咪定0. 5μg/(kg·h),记录手术开始切皮(T0)、分离肌肉韧带组织(T1)、术中刺激神经根(T2)、摘除髓核(T3)、缝合皮肤(T4)时的HR、MAP、VAS评分,采用Bromage改良法记录术中的下肢运动功能,采用Ramsay评分实施镇静分级。结果:T2和T3时间点A组HR、MAP、VAS评分均显著高于B、C组(P <0. 05),B、C组各时间点上述指标差异均无统计学意义(P>0. 05)。A组镇静不足发生率显著高于B、C组(P <0. 05),B、C组镇静不足发生率差异无统计学意义(P> 0. 05); C组运动阻滞发生率显著高于A、B组(P <0. 05),A、B组运动阻滞发生率差异无统计学意义(P> 0. 05)。结论:右美托咪定0. 5μg/(kg·h)持续静脉泵注联合0. 375%罗哌卡因行硬膜外麻醉后实施PELD安全有效。
Objective: To explore the optimal effective concentration of dexmedetomidine sedation combined with epidural anesthesia with different concentrations of ropivacaine in percutaneous endoscopic lumbar discectomy( PELD). Methods: 120 patients undergoing PELD were randomly divided into three groups,40 cases in each group. Group A,B and C were given0. 25%,0. 375% and 0. 5% ropivacaine,respectively. The HR,MAP and VAS scores were recorded at the beginning of skin incision( T_0),muscle ligament dissection( T_1),nerve root stimulation( T_2),nucleus pulposus removal( T_3) and skin suture( T_4). The lower limb motor function was recorded by Bromage's modified method,and the sedation grading was evaluated by Ramsay score. Results: HR,MAP and VAS scores in group A were significantly higher than those in group B and C at T_2 and T_3( P < 0. 05) There was no significant difference between group B and group C at all time points( P > 0. 05). The incidence of insufficient sedation in group A was significantly higher than that in group B and group C( P < 0. 05),but it was not significantly different between group B and group C( P > 0. 05); the incidence of motor block in group C was significantly higher than that in group A and B( P < 0. 05),but it was not significantly different between group A and group B( P > 0. 05). Conclusion: PELD can be performed safely and effectively after continuous intravenous infusion with dexmedetomidine at a constant rate of 0. 5 μg/( kg·h)combined with epidural anesthesia with 0. 375% ropivacaine is safe and effective
Objective: To explore the optimal effective concentration of dexmedetomidine sedation combined with epidural anesthesia with different concentrations of ropivacaine in percutaneous endoscopic lumbar discectomy( PELD). Methods: 120 patients undergoing PELD were randomly divided into three groups,40 cases in each group. Group A,B and C were given0. 25%,0. 375% and 0. 5% ropivacaine,respectively. The HR,MAP and VAS scores were recorded at the beginning of skin incision( T_0),muscle ligament dissection( T_1),nerve root stimulation( T_2),nucleus pulposus removal( T_3) and skin suture( T_4). The lower limb motor function was recorded by Bromage's modified method,and the sedation grading was evaluated by Ramsay score. Results: HR,MAP and VAS scores in group A were significantly higher than those in group B and C at T_2 and T_3( P < 0. 05) There was no significant difference between group B and group C at all time points( P > 0. 05). The incidence of insufficient sedation in group A was significantly higher than that in group B and group C( P < 0. 05),but it was not significantly different between group B and group C( P > 0. 05); the incidence of motor block in group C was significantly higher than that in group A and B( P < 0. 05),but it was not significantly different between group A and group B( P > 0. 05). Conclusion: PELD can be performed safely and effectively after continuous intravenous infusion with dexmedetomidine at a constant rate of 0. 5 μg/( kg·h)combined with epidural anesthesia with 0. 375% ropivacaine is safe and effective
引文
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[3]SAIRYO K,EGAWA H,MATSUURA T,et al. State of the art:transforaminal approach for percutaneous endoscopic lumbar discectomy under local anesthesia[J]. J Med Invest,2014,61(3/4):217-225.
[4]夏若林,王雪枝.帕瑞昔布钠联合芬太尼在经皮椎间孔镜局部麻醉手术中的效果观察[J].中国医药导报,2013,10(34):92-94.
[5]杨文荣,于洋,孙明洁,等.右美托咪定在经皮穿刺椎间孔镜手术的应用[J].中国疼痛医学杂志,2015,21(8):623-625.
[6]李京生,张建华,田肇隆.右美托咪定在椎间孔镜手术中应用的临床研究[J].北京医学,2016,38(3):230-232.
[2]祝斌,刘晓光.经皮腰椎内窥镜下手术麻醉方案选择的前瞻性随机对照研究[J].中国脊柱脊髓杂志,2015,25(12):1069-1072.
[3]SAIRYO K,EGAWA H,MATSUURA T,et al. State of the art:transforaminal approach for percutaneous endoscopic lumbar discectomy under local anesthesia[J]. J Med Invest,2014,61(3/4):217-225.
[4]夏若林,王雪枝.帕瑞昔布钠联合芬太尼在经皮椎间孔镜局部麻醉手术中的效果观察[J].中国医药导报,2013,10(34):92-94.
[5]杨文荣,于洋,孙明洁,等.右美托咪定在经皮穿刺椎间孔镜手术的应用[J].中国疼痛医学杂志,2015,21(8):623-625.
[6]李京生,张建华,田肇隆.右美托咪定在椎间孔镜手术中应用的临床研究[J].北京医学,2016,38(3):230-232.