右旋美托咪定作为佐剂可减少骨外科下肢手术时蛛网膜下腔麻醉时布.PDF

右旋美托咪定作为佐剂可减少骨外科下肢手术时蛛网膜下腔麻醉时 布比卡因用Dexmedetomidine as Adjuvant to Lower Doses of Intrathecal Bupivacaine for Lower Limb Orthopedic Surgeries 摘要 背景：右旋美托咪定，是一种 α2 肾上腺素能激动剂，已证实对局 麻有益。已经证实它同较低剂量的布比卡因协同使用能产生令人满 意的椎管阻滞效果。 目的：本研究的目的是比较蛛网膜下腔阻滞协同使用7、8、9 毫克 高比重布比卡因与5 微克右旋美托咪定时的特点和对血流动力学的 影响，并找出能为骨外科下肢手术提供满意阻滞效果和血流动力学 稳定性的最佳剂量。 方法; 90 名接受骨外科下肢手术的病人分为三组，每组30 人。 A,B,C 组分别注入7 毫克，8 毫克，9 毫克0.5% 的高比重布比卡因以 及5 微克的右旋美托咪定。然后比较三组蛛网膜下腔阻滞的特点、 血流动力学稳定性和副作用。 结果：这三个组的麻醉效果和镇痛作用都令人满意。A 组镇痛作用 较慢，感觉阻滞最高水平位置较低。比较三组运动阻滞起始时间， 达到感觉阻滞最高水平位置时间，镇痛持续时间，最高疼痛评分， 以及追加镇痛药需求。在C 组中，运动阻滞持续时间和感觉水平回 归时间较长，而血液动力学和镇静评分则是相当的。 结论：用较低剂量的布比卡因与右旋美托咪定合用可以产生令人满 意的麻醉效果，并且不会导致血液动力学的不稳定性。7 毫克布比 卡因和5 微克右旋美托咪定合用，对骨外科手术来说足够了。 原文摘要：Background: Dexmedetomidine, an α2 adrenergic agonist, has been found to be a useful adjuvant to local anesthetics. It has been found to produce satisfactory block with lower doses of spinal bupivacaine. Aim: The aim of this study is to compare the difference in spinal block characteristics and hemodynamic effects of 7, 8, and 9 mg hyperbaric bupivacaine combined with 5 μg dexmedetomidine and to find out the optimum dose that would provide satisfactory block and hemodynamic stability for lower limb orthopedic surgeries. Settings and Study Design: This was a prospective, observational study. Materials and Methods: Ninety patients undergoing lower limb orthopedic surgeries were allocated to three groups of thirty each. Group A received 7 mg, Group B 8 mg and Group C 9 mg 0.5% hyperbaric bupivacaine along with dexmedetomidine 5 μg. The spinal block characteristics, hemodynamic stability, and side effects were compared. Statistical Analysis: The quantitative variables were compared using ANOVA test and the qualitative variables using Chi-square test. Results: All three groups had satisfactory anesthesia and analgesia. The onset of analgesia was slower and peak sensory level lower in Group A. The onset of motor block, tim