本文選題：右美托咪定　切入點：蛛網(wǎng)膜下隙與硬脊膜外隙聯(lián)合麻醉　出處：《華西醫(yī)學(xué)》2016年03期

【摘要】：目的觀察不同劑量右美托咪定輔助蛛網(wǎng)膜下隙與硬脊膜外隙聯(lián)合麻醉(腰硬聯(lián)合麻醉)在腹腔鏡完全腹膜外疝修補術(shù)(TEP)中應(yīng)用的有效性、安全性。方法 2010年1月-2013年1月選擇擇期行TEP患者90例,分為M1組、M2組、M3組,每組30例,左側(cè)臥位,選擇腰3-4間行腰硬聯(lián)合麻醉,注入0.5%布比卡因2 m L,硬膜外腔置管3~5 cm,調(diào)節(jié)麻醉平面在胸4或胸6至骶椎,M1組、M2組、M3組分別用微量泵輸注右美托咪定預(yù)充量0.5μg/kg后,M1組以0.3μg/(kg·h)維持;M2組以0.5μg/(kg·h)維持;M3組以0.7μg/(kg·h)維持。觀察各時段的平均動脈壓(MAP)、心率、呼吸和脈搏血氧飽和度(SpO_2)的變化,同時行腦電雙頻譜指數(shù)(BIS)監(jiān)測及進(jìn)行Ramsay鎮(zhèn)靜評分。結(jié)果 M1組患者M(jìn)AP、心率、呼吸變化不明顯,Ramsay評分2~3分,BIS值在給預(yù)充量后65~84;M2組患者M(jìn)AP、心率、呼吸出現(xiàn)輕微下降,Ramsay評分3~5分,BIS值在60~79;M3組患者M(jìn)AP和呼吸出現(xiàn)較輕微的下降,心率在給予右美托咪定后出現(xiàn)明顯下降,個例嚴(yán)重下降處理后好轉(zhuǎn),Ramsay評分5~6分,BIS值在55~75。各組的SpO_2變化不大,比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論腰硬聯(lián)合麻醉聯(lián)合持續(xù)輸注0.3~0.5μg/(kg·h)右美托咪定可有效輔助鎮(zhèn)痛鎮(zhèn)靜,抑制氣腹的不適,是一種可選擇的麻醉方式。
[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.
【作者單位】： 青島市膠州中心醫(yī)院麻醉科;
【分類號】：R614

【共引文獻(xiàn)】

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