盐酸右美托咪定联合瑞芬太尼在骨科手术中的镇静效果及对患者血流动力学和呼吸功能的影响

目的:探讨盐酸右美托咪定联合瑞芬太尼在骨科手术中的镇静效果及对患者血流动力学和呼吸功能的影响。方法:选择2016年3月至2017年5月在我院186例行骨科手术的患者,根据数表法随机分为对照组(93例)和观察组(93例),对照组采用丙泊酚联合瑞芬太尼进行麻醉,观察组采用盐酸右美托咪定联合瑞芬太尼进行麻醉,比较两组用药前(T_1)、联合用药后10 min(T_2)、联合用药后20 min(T_3)、联合用药后30 min(T_4)和患者清醒后(T_5)等时间点的镇静效果以及血流动力学和呼吸功能指标变化,并比较两组不良反应发生率。结果:T_3、T_4时间点两组警觉/镇静(OAA/S)评分低于组内其他时间点,且观察组OAA/S评分低于对照组(P0.05)。两组T_1、T_5时间点呼吸频率(RR)、血氧饱和度(SpO_2)比较差异无统计学意义(P0.05);在T_2、T_3、T_4时间点观察组RR、SpO_2高于对照组(P0.05);T_3、T_4时间点两组的RR水平均低于组内其他时间点(P0.05)。两组各时间点平均动脉压(MAP)、心率(HR)水平比较差异均无统计学意义(P0.05)。观察组呼吸抑制、呼吸道梗塞和恶心呕吐的发生率低于对照组(P0.05)。结论:盐酸右美托咪定联合瑞芬太尼在骨科手术中镇静效果良好,对患者血流动力学的影响较小,呼吸抑制程度轻,安全性好。

Sedative Effect of Hydrochloride Dexmedetomidine Combine with Remifentanil in Orthopedics Surgery and Its Influence on Hemodynamics and Respiratory Function

ABSTRACT Objective: To explore the sedative effect of hydrochloride dexmedetomidine combine with remifentanil in the orthope- dics surgery and its influence on hemodynamics and respiratory function. Methods: A total of 186 patients, who underwent orthopedics surgery in Tangshan People''s Hospital from March 2016 to May 2017, were selected and randomly divided into observation group (93 cases) and control group (93 cases). The control group received propofol combined with remifentanil for anesthesia; the observation group received hydrochloride dexmedetomidine combined with remifentanil for anesthesia. The sedative effect between the two groups before treatment (T₁), 10 min after combined use of drugs (T₂), 20min after combined use of drugs (T₃), 30 min after combined use of drugs (T₄) and after the patients were conscious(T₅) and hemodynamics and respiratory function were compared, and the incidence of ad- verse reactions was compared between the two groups. Results: The Alertness / sedation (OAA/S) scores of the two groups at T₃ and T₄ time points were lower than those at other time points in the two group, and the OAA/S score of the observation group was lower than that of the control group (P<0.05). There were no significant differences in respiratory rate (RR) and oxygen saturation (SpO₂) between the two groups at T₁ and T₅ time points (P>0.05). At the time of T₂, T₃ and T₄, the RR and SpO₂ of the observation group were higher than those of the control group (P<0.05). The RR levels of the two groups at T₃ and T₄ time points were lower than those of the other time points (P<0.05). There were no significant differences in mean arterial pressure (MAP) and heart rate (HR) between the two groups at each time point (P>0.05). The incidence of respiratory depression, respiratory tract infarction and nausea and vomiting in the observation group was lower than that in the control group (P<0.05). Conclusion: Hydrochloride dexmedetomidine combined with remifentanil has a good sedative effect in the orthopedics surgery, with less influence on hemodynamics, mild respiratory depression and good safety.