【2017年整理】1右美托咪啶与哌替啶治疗硬膜外麻醉后寒战效果的比较.doc

右美托咪定与哌替啶治疗硬膜外麻醉致寒战反应效果的比较 李坤 牛金柱 刘明 兰海涛 王卉 常诚 作者单位：030001 太原，解放军264医院麻醉科 【摘要】目的?比较右美托咪定与哌替啶静脉注射用于治疗硬膜外麻醉致寒战反应的效果。方法? 选择下肢手术硬膜外麻醉后发生寒战反应级别为3～4级的患者60例，ASA分级Ⅰ～Ⅱ级，随机均分为两组：在寒战出现时分别缓慢静脉注射右美托咪定0.4ug/kg(D组)、哌替啶0.5mg/kg(P组)，注入时间5min，每组30例，所有药物均用生理盐水稀释至10ml。观察注药前及注药完毕后1、3、5、10min两组患者平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）的变化，注药后10min患者寒战的转归情况及不良反应发生率。结果? 两组患者寒战治疗有效率组间比较差异无统计学意义(P0.05)，P组寒战复发率较D组高（P0.05）；与注药前及D组比较，P组注药后HR在1、3、5min各时点增加而SpO2在5、10min时点下降，差异均有统计学意义（P0.05）；P组头晕、嗜睡、恶心呕吐、皮肤瘙痒不良反应发生率均较D组高（P0.05）。结论 右美托咪啶和哌替啶均可以有效治疗硬膜外麻醉引起的寒战反应，但右美托咪啶的不良反应更小，且寒战的复发率低。【关键词】右美托咪啶；哌替啶；硬膜外麻醉?；寒战 ；麻醉并发症 Comparison of effect of intravenous injection of Dexmedetomidine and Pethidine to cure shiver reaction resulted by epidural anesthesia Likun, Niu Jinzhu, LiuMing, LanHaitao, WangHui, ChangCheng(Department of Anesthesiology，the 264th hospital of PLA，ShanXi, Taiyuan 030001，China) [Abstract ] Objective To compare effect of intravenous injection of Dexmedetomidine and pethidine to cure shiver reaction resulted by epidural anesthesia。Method：to select 60 patients whose shiver reaction level is 3-4 level after epidural anesthesia for lower limbs operation, and ASA ranked between I-II. All the patients is divided to two groups(D and P group) averagely and randomly. When shiver reaction appears, patients of the D group are intravenous injected with Dexmedetomidine (0.4ug/kg) slowly, patients of P group are injected with pethidine(0.5mg/kg), both groups are injected for 5 min, and all the medicine is diluted to 10ml by normal saline (NS). Changes of MAP, HR, SpO2 are recorded before medication and 1,3,5, 10 min after medication. Outcome of shiver reaction and occurrence rate 10 min after medication is observed. Result: there is no statistical difference between ereffective rate of two groups(P0.05), and recurrence rate of P group is higher than D group(P0.05). When compared with HR before medicaiton and D group, HR of P group increased at the time of 1,3,5 min after medication, and SpO2 reduced at the