右美托咪定与曲马多对腰硬联合麻醉下老年TURP患者术中寒战影响.docVIP

右美托咪定与曲马多对腰硬联合麻醉下老年TURP患者术中寒战影响 　　[摘要] 目的 比较右美托咪定与曲马多对腰-硬联合麻醉下老年经尿道前列腺电切术（TURP）患者术中寒战的影响。方法 选择本院2014年5月～2015年6月于腰-硬联合麻醉下择期行TURP手术老年患者60例，年龄65～80岁，ASAⅠ～Ⅱ级，随机分为右美托咪定组（D组）和曲马多组（T组），每组30例，分别于腰硬联合麻醉后静脉缓慢泵注右美托咪定0.5 μg/kg、曲马多0.5 mg/kg，10 min输注完毕。观察两组患者术中寒战发生率、寒战分级及镇静程度，并记录两组患者术中低血压、心动过缓、恶心呕吐等不良反应。 结果 D组寒战发生率和寒战分级均低于T组（P0.05）；恶心、呕吐等不良反应仅见于T组，分别为30.0%与16.7%（P0.05）。 结论 0.5 μg/kg右美托咪定可有效防治腰-硬联合麻醉下老年TURP患者术中寒战反应，血流动力学稳定，无明显不良反应，与曲马多所致的恶心、呕吐等不良反应相比，患者舒适度更高。 　　[关键词] 右美托咪定；曲马多；老年；TURP；寒战 　　[中图分类号] R699 [文献标识码] B [文章编号] 1673-9701（2015）34-0111-03 　　Effects of dexmedetomidine and tramadol on perioperative shivering in elderly transurethral prostatectomy patients with combined spinal-epidural anesthesia 　　XU Zhifei LIANG Dongliang TANG Zairong YAO Juan 　　Department of Anesthesiology， Gaoyou TCM Hospital （East Area） of Gaoyou City in Jiangsu Province， Gaoyou 225600， China 　　[Abstract] Objective To observe the effects of dexmedetomidine and tramadol on perioperative shivering in elderly patients undergoing transurethral prostatectomy. Methods Sixty elderly patients in our hospital from May 2014 to June 2015， aged 65 to 80 years old， ASAⅠ-Ⅱ， scheduled for transurethral prostatectomy under combined spinal-epidural anesthesia were randomly allocated to receive dexmedetomidine 0.5 μg/kg （group D， n=30）， and tramadol 0.5 mg/kg （group T， n=30）， as a slow intravenous bolus in 10 min after anesthesia procedure. Response rate， grade of shivering， and adverse effects such as hypotension， bradycardia， nausea and vomiting were observed at scheduled intervals. Results Response rate and grade of shivering in group D were significantly lower than that of group T（P0.05）. Conclusion Compare to tramadol， 0.5 μg/kg dexmedetomidine is an effective drug without any major adverse effect on perioperative shivering in elderly patients undergoing TURP. 　　[Key words] Dexmedetomidine； Tramadol； Elderly； TURP； Shivering 　　寒战为机体调节体温过低而主动增加机体代谢的反应，表现为反复、不自主的骨骼肌活动。围麻醉期寒战发生率可高达40%～50%[1]，可导致一系列生理改变，常使患者感觉不适、