右美托咪定辅助蛛网膜下隙与硬脊膜外隙联合麻醉在腹腔镜完全腹膜外疝修补术中的应用研究

发布时间：2018-03-29 16:17

本文选题：右美托咪定　切入点：蛛网膜下隙与硬脊膜外隙联合麻醉　出处：《华西医学》2016年03期

【摘要】：目的观察不同剂量右美托咪定辅助蛛网膜下隙与硬脊膜外隙联合麻醉(腰硬联合麻醉)在腹腔镜完全腹膜外疝修补术(TEP)中应用的有效性、安全性。方法 2010年1月-2013年1月选择择期行TEP患者90例,分为M1组、M2组、M3组,每组30例,左侧卧位,选择腰3-4间行腰硬联合麻醉,注入0.5%布比卡因2 m L,硬膜外腔置管3~5 cm,调节麻醉平面在胸4或胸6至骶椎,M1组、M2组、M3组分别用微量泵输注右美托咪定预充量0.5μg/kg后,M1组以0.3μg/(kg·h)维持;M2组以0.5μg/(kg·h)维持;M3组以0.7μg/(kg·h)维持。观察各时段的平均动脉压(MAP)、心率、呼吸和脉搏血氧饱和度(SpO_2)的变化,同时行脑电双频谱指数(BIS)监测及进行Ramsay镇静评分。结果 M1组患者MAP、心率、呼吸变化不明显,Ramsay评分2~3分,BIS值在给预充量后65~84;M2组患者MAP、心率、呼吸出现轻微下降,Ramsay评分3~5分,BIS值在60~79;M3组患者MAP和呼吸出现较轻微的下降,心率在给予右美托咪定后出现明显下降,个例严重下降处理后好转,Ramsay评分5~6分,BIS值在55~75。各组的SpO_2变化不大,比较差异无统计学意义(P0.05)。结论腰硬联合麻醉联合持续输注0.3~0.5μg/(kg·h)右美托咪定可有效辅助镇痛镇静,抑制气腹的不适,是一种可选择的麻醉方式。
[Abstract]:Objective to observe the efficacy of different doses of dexmetidine in combined subarachnoid and epidural space anesthesia (combined spinal-epidural anesthesia) in laparoscopic total extraperitoneal herniorrhaphy. Methods from January 2010 to January 2013, 90 patients with TEP were divided into M1 group (M _ 2 group), M _ 2 group (n = 30), left lying position group (n = 30) and lumbar epidural anesthesia group (n = 3-4). 0.5% bupivacaine was injected into 2 mL, and epidural cavity was inserted with a tube of 35 cm. The anesthesia level was adjusted by micropump infusion of dexmetidine (0.5 渭 g/(kg / h) and maintenance of M _ 3 (0.5 渭 g/(kg / h) in M _ 2 group (n = 4) or from chest 6 to sacrum M _ 1 group (n = 2), respectively, by micropump infusion of dexmetidine at 0.5 渭 g/(kg / h and by a dose of 0.5 渭 g/(kg / h in M _ 2 group. The mean arterial pressure and heart rate were observed. At the same time, the bispectral index (BIS) of EEG and the Ramsay sedative score were measured. Results in M1 group, there were no significant changes in mitogen, heart rate and respiration. There was a slight decrease in MAP and respiration and a significant decrease in heart rate after dexmetomidine was given to the patients in the 609 / 79 M _ 3 group, and there was a slight decrease in the MAP and respiration in the patients with 3 ~ 5 scores of Ramsay score, and a significant decrease in the heart rate after treatment with dexmetoimidine. The SpO_2 of each group was not changed significantly (P 0.05). Conclusion combined spinal-epidural anesthesia combined with continuous infusion of 0.3- 0.5 渭 g/(kg / h, dexmetomidine can effectively assist analgesia and sedation. Inhibition of pneumoperitoneum discomfort is an alternative form of anesthesia.
【作者单位】：青岛市胶州中心医院麻醉科;
【分类号】：R614

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