本文選題：關(guān)節(jié)成形術(shù)　切入點(diǎn)：膝　出處：《中國(guó)組織工程研究》2015年22期 　論文類型：期刊論文

【摘要】：背景:高齡膝關(guān)節(jié)置換過(guò)程中硬膜外麻醉是一種常用的麻醉方式。右美托咪啶因具有良好的鎮(zhèn)痛效果,被廣泛應(yīng)用于高齡膝關(guān)節(jié)置換硬膜外麻醉中,但不同的右美托咪啶應(yīng)用劑量可能會(huì)導(dǎo)致不同的效果。目的:探討高齡膝關(guān)節(jié)置換過(guò)程中不同劑量右美托咪啶的硬膜外麻醉效果。方法:從膝關(guān)節(jié)置換的高齡患者中選擇75例進(jìn)行研究,隨機(jī)分為右美托咪啶負(fù)荷加維持組、右美托咪啶維持組和生理鹽水組,每組25例,分別給予小劑量右美托咪啶負(fù)荷加維持、右美托咪啶維持、靜脈滴注等容量生理鹽水。測(cè)定3組患者不同時(shí)間的血壓、心率、鎮(zhèn)靜/警覺(jué)評(píng)分以及手術(shù)操作遺忘程度,并進(jìn)行比較,觀察時(shí)間點(diǎn)包括T0(硬膜外麻醉后),T1(用藥后3 min),T2(用藥后5 min),T3(用藥后10 min),T4(用藥后15 min),T5(用藥后30 min)。結(jié)果與結(jié)論:用藥之后,右美托咪啶負(fù)荷加維持組和右美托咪啶維持組患者的血壓和心率均出現(xiàn)下降,其中右美托咪啶負(fù)荷加維持組明顯低于右美托咪啶維持組(P0.05),且在T3時(shí)相最慢,右美托咪啶維持組以T4時(shí)相最慢(P0.05);用藥后5 min,右美托咪啶負(fù)荷加維持組、右美托咪啶維持組的鎮(zhèn)靜/警覺(jué)評(píng)分均出現(xiàn)下降現(xiàn)象;T3時(shí)右美托咪啶負(fù)荷加維持組患者出現(xiàn)深度鎮(zhèn)靜且心率明顯下降,需給予阿托品方能改善,T4時(shí)右美托咪啶維持組評(píng)分最低(P0.05),但未出現(xiàn)深度鎮(zhèn)靜,血壓、心率下降程度較右美托咪啶負(fù)荷加維持組輕。右美托咪啶負(fù)荷加維持組和右美托咪啶維持組、生理鹽水組對(duì)手術(shù)相關(guān)操作的完全遺忘程度分別為72%,68%,0%,右美托咪啶負(fù)荷加維持組和右美托咪啶維持組均顯著高于生理鹽水組(P0.05),但兩組間比較差異無(wú)顯著性意義(P0.05)。表明在高齡患者膝關(guān)節(jié)置換過(guò)程中,予以小劑量右美托咪啶持續(xù)泵注硬膜外麻醉可以達(dá)到良好的鎮(zhèn)痛、鎮(zhèn)靜效果,并消除患者對(duì)手術(shù)操作的不良記憶,是一種較為科學(xué)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.
【作者單位】： 遼寧中醫(yī)藥大學(xué)附屬第二醫(yī)院麻醉科;
【分類號(hào)】：R614

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