高龄膝关节置换过程中应用右美托咪啶硬膜外麻醉剂量的选择

发布时间：2018-03-21 00:14

本文选题：关节成形术　切入点：膝　出处：《中国组织工程研究》2015年22期 　论文类型：期刊论文

【摘要】：背景:高龄膝关节置换过程中硬膜外麻醉是一种常用的麻醉方式。右美托咪啶因具有良好的镇痛效果,被广泛应用于高龄膝关节置换硬膜外麻醉中,但不同的右美托咪啶应用剂量可能会导致不同的效果。目的:探讨高龄膝关节置换过程中不同剂量右美托咪啶的硬膜外麻醉效果。方法:从膝关节置换的高龄患者中选择75例进行研究,随机分为右美托咪啶负荷加维持组、右美托咪啶维持组和生理盐水组,每组25例,分别给予小剂量右美托咪啶负荷加维持、右美托咪啶维持、静脉滴注等容量生理盐水。测定3组患者不同时间的血压、心率、镇静/警觉评分以及手术操作遗忘程度,并进行比较,观察时间点包括T0(硬膜外麻醉后),T1(用药后3 min),T2(用药后5 min),T3(用药后10 min),T4(用药后15 min),T5(用药后30 min)。结果与结论:用药之后,右美托咪啶负荷加维持组和右美托咪啶维持组患者的血压和心率均出现下降,其中右美托咪啶负荷加维持组明显低于右美托咪啶维持组(P0.05),且在T3时相最慢,右美托咪啶维持组以T4时相最慢(P0.05);用药后5 min,右美托咪啶负荷加维持组、右美托咪啶维持组的镇静/警觉评分均出现下降现象;T3时右美托咪啶负荷加维持组患者出现深度镇静且心率明显下降,需给予阿托品方能改善,T4时右美托咪啶维持组评分最低(P0.05),但未出现深度镇静,血压、心率下降程度较右美托咪啶负荷加维持组轻。右美托咪啶负荷加维持组和右美托咪啶维持组、生理盐水组对手术相关操作的完全遗忘程度分别为72%,68%,0%,右美托咪啶负荷加维持组和右美托咪啶维持组均显著高于生理盐水组(P0.05),但两组间比较差异无显著性意义(P0.05)。表明在高龄患者膝关节置换过程中,予以小剂量右美托咪啶持续泵注硬膜外麻醉可以达到良好的镇痛、镇静效果,并消除患者对手术操作的不良记忆,是一种较为科学的麻醉方式。
[Abstract]:Background: epidural anesthesia is a common anaesthesia during knee arthroplasty in the elderly. Dexmetidine has been widely used in epidural anesthesia for knee arthroplasty in elderly because of its good analgesic effect. But different doses of dexmetidine may lead to different effects. Objective: to investigate the epidural anaesthesia effect of dexmetidine at different doses during knee arthroplasty. Methods: to study the effects of epidural anesthesia with different doses of dexmetidine during knee arthroplasty. 75 patients were selected for the study. They were randomly divided into three groups: dexmetidine loading plus maintenance group, dexmetomidine maintenance group and normal saline group. Each group was treated with low-dose dexmetomidine plus maintenance and dexmetomidine maintenance. The blood pressure, heart rate, sedation / alertness score and the degree of amnesia during operation were measured and compared among the three groups. The observed time points included T0 (T1 after epidural anesthesia) (T1 after epidural anesthesia) (T2 after 3 mins) (T3 + T3 at 5 min after administration (T4 at 10 min after administration) (T5 at 15 min after epidural anesthesia) (30 min after treatment). Results and conclusions: after treatment, The blood pressure and heart rate of patients with dexmetidine load plus maintenance group and dexmetomidine maintenance group were decreased, and the blood pressure and heart rate of dexmetomidine plus maintenance group were significantly lower than that of dexmetomidine maintenance group (P 0.05), and the slowest at T3 phase. In the dexmetidine maintenance group, the slowest phase was T4 phase P0.05A, and 5 min after administration, the dexmetidine loading plus maintenance group, The sedation / alertness scores of desmetomidine maintenance group were all decreased. The patients with dexmetomidine load plus maintenance group had deep sedation and heart rate decreased significantly. The treatment of atropine could improve the score of dexmetidine maintenance group with the lowest score (P0.05), but there was no deep sedation and blood pressure. The degree of heart rate decrease was lighter than that of dexmetidine load plus maintenance group, dexmetomidine load plus maintenance group and dexmetomidine maintenance group. The degree of complete amnesia of the operation related operations in the saline group was 720.The dexmetidine load plus maintenance group and dexmetomidine maintenance group were significantly higher than those in the normal saline group (P 0.05), but there was no significant difference between the two groups (P 0.05). In the process of knee arthroplasty in elderly patients, It is a more scientific anaesthesia method to give low dose dexmetidine continuous pump epidural anesthesia to achieve good analgesic and sedative effect and to eliminate patients' bad memory of operation.
【作者单位】：辽宁中医药大学附属第二医院麻醉科;
【分类号】：R614

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