静脉辅助右美托咪定复合瑞芬太尼在腰丛-坐骨神经阻滞下老年髋关节置换术中对镇痛与应激的影响

发布时间：2018-06-24 00:56

本文选题：右美托咪定 + 瑞芬太尼　；参考：《中国老年学杂志》2017年05期

【摘要】：目的探讨静脉辅助右美托咪定复合瑞芬太尼在腰丛-坐骨神经阻滞下老年患者髋关节置换术中对镇痛与应激的影响。方法在超声联合神经刺激引导的腰丛-坐骨神经阻滞下髋关节置换术中,分别辅以一定剂量右美托咪定、瑞芬太尼或两药复合应用。采用随机数字表法,将患者随机分为4组(n=30):D组为右美托咪定负荷量0.5μg/kg(10 min泵注),随即以0.3μg·kg~(-1)·h~(-1)泵注维持;R1组为瑞芬太尼0.05μg·kg~(-1)·min~(-1)持续泵注;R2组为瑞芬太尼0.1μg·kg~(-1)·min~(-1)持续泵注;DR组为瑞芬太尼0.05μg·kg~(-1)·min~(-1)持续泵注,同时右美托咪定负荷量0.5μg·kg(10 min泵注),随即以0.3μg·kg~(-1)·h~(-1)泵注维持。各组均于静脉用药10 min后行腰丛-坐骨神经阻滞,且均于术毕前10 min停药。在入室时(T0)、神经阻滞操作前(T1)、手术切皮即刻(T2)、手术开始后15 min(T3)、手术开始后30 min(T4)、术毕即刻(T5)各时间点,通过疼痛视觉模拟评分(VAS)监测镇痛效果,血浆皮质醇(Cor)检测应激影响。结果 D组与R1组T1、T2、T5时刻VAS均降低(P0.05);R2组与DR组T1~T5时刻VAS均降低(P0.05)。DR组在各时间点VAS评分与R2组均无显著差别,但显著优于D组和R1组。各组各时刻Cor水平均有明显降低(P0.05)。D组Cor水平除T2、T3时刻与R2组无显著差异之外,其余各时间点均低于R1、R2组。DR组各时间点Cor水平均低于R1、R2组,除T1时刻之外,在其余各时刻Cor水平显著低于D组。结论腰丛-坐骨神经阻滞麻醉下老年患者髋关节置换术中,给予右美托咪定负荷量0.5μg·kg(10 min)、0.3μg·kg~(-1)·h~(-1)维持复合瑞芬太尼0.05μg·kg~(-1)·min~(-1)静脉维持,降低了阿片类药物的消耗,能够提供更佳的镇痛效果,并充分抑制应激反应。
[Abstract]:Objective to investigate the effect of intravenous dexmetidine combined with remifentanil on analgesia and stress in elderly patients undergoing lumbar plexus-sciatic nerve block. Methods in hip arthroplasty under lumbar plexus-sciatic nerve block guided by ultrasound and nerve stimulation, a certain dose of dexmetoimidine, remifentanil or two drugs were used respectively. Using random digital tables, The patients were randomly divided into 4 groups (n = 30): d: 0. 5 渭 g/kg (10 min), followed by remifentanil 0. 5 渭 g kg ~ (-1) min ~ (-1) continuous infusion of remifentanil 0. 5 渭 g kg ~ (-1) min ~ (-1), followed by remifentanil 0. 05 渭 g kg ~ (-1) min ~ (-1) in the Dr group (0. 05 渭 g kg ~ (-1) min ~ (-1) for remifentanil (0. 05 渭 g kg ~ (-1) min ~ (-1) in the remifentanil 0. 5 渭 g kg ~ (-1) min ~ (-1) group. At the same time, the dose of dexmetidine was injected with 0. 5 渭 g kg (10 min, then maintained with 0. 3 渭 g kg-1 h-1 pump. All groups were treated with lumbar plexus sciatic nerve block 10 min after intravenous administration, and were stopped 10 min before the end of operation. The analgesic effect was monitored by pain visual analogue score (VAS) and plasma cortisol (Cor) at room entry (T0), nerve block operation (T1), immediate skin incision (T2), 15 min (T3) after operation, 30 min (T4) after operation and immediately after operation (T5). Results the VAS of group D and group R1 were decreased at T1T2T5 (P0.05). The VAS of group R 2 and group R 2 were significantly lower than that of group R 2 at different time points (P0.05). There was no significant difference between group Dr and group R 2 at each time point, but it was significantly better than that of group D and group R1. The level of Cor in group D was significantly lower than that in group R 1 (P 0.05). The level of Cor in group D was lower than that in group R 1 (P 0.05), except T 2 T 3 and R 2, the other time points were lower than those in group R 1 and R 2, except T 1 and T 1, respectively. At other times, the level of Cor was significantly lower than that in group D. Conclusion in hip arthroplasty under lumbar plexus-sciatic nerve block anesthesia, dexmetomidine loading of 0.5 渭 g kg (~ (10 min) and remifentanil (0. 5 渭 g kg ~ (-1) h ~ (-1) were used to maintain intravenous remifentanil in elderly patients, which reduced the consumption of opiates and provided better analgesic effect. And fully inhibited the stress response.
【作者单位】：承德医学院附属医院麻醉科;承德市中医院麻醉科;
【分类号】：R614.4

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