右美托咪定复合丙泊酚全麻对腰椎手术患者镇痛效果及术后恢复的影响

目的:探讨右美托咪定复合丙泊酚全麻对腰椎手术患者镇痛效果及术后恢复的影响。方法:选择我院于2015年10月~2016年10月择期行腰椎全麻手术患者92例,经随机数字表法分为观察组及对照组各46例,两组麻醉诱导方案相同,于麻醉诱导前给予观察组静脉泵入右美托咪啶,给予对照组静脉泵入生理盐水。术后均采用经静脉自控镇痛。记录两组患者麻醉诱导前(T0)、插管1 min(T1)、插管5 min(T2)、拔管后1 h(T3)及术毕(T4)的收缩压(SBP)、舒张压(DBP)、血氧饱和度(SPO_2)和心率(HR)。比较两组患者拔管后即刻疼痛及镇静情况。记录两组患者定向力恢复时间、苏醒时间、拔管时间以及吗啡使用剂量。统计两组患者不良反应情况。结果:两组患者T1时刻SBP、DBP水平较T0明显下降,对照组T3时刻SBP水平高于T0,差异有统计学意义(P0.05);观察组T1时刻DBP、SBP水平高于对照组,T3时刻SBP水平低于对照组,差异均有统计学意义(P0.05);T1、T2、T3、T4时刻观察组HR水平明显高于对照组,差异均有统计学意义(P0.05);拔管后观察组视觉模拟评分(VAS)低于对照组,而Ramasy评分高于对照组,差异有统计学意义(P0.05)。观察组吗啡使用剂量明显低于对照组,差异有统计学意义(P0.05),两组苏醒时间、定向力恢复时间以及拔管时间差异均无统计学意义(P0.05),两组不良反应发生率差异无统计学意义(P0.05)。结论:采用右美托咪定复合丙泊酚全麻对腰椎手术患者血流动力学的影响小,镇痛、镇静效果显著,术后镇痛药物使用量减少,值得临床推广。

Effect of Dexmedetomidine Combined with Propofol on Analgesia and Postoperative Recovery in Patients with Lumbar Surgery

ABSTRACT Objective: To investigate the effect of dexmedetomidine combined with propofol on analgesia and postoperative recovery in patients with lumbar surgery. Methods: Selected 92 patients underwent elective lumbar anesthesia surgery in our hospital from October 2015 to October 2016. The patients were randomly divided into observation group and control group with 46 cases in each group. The two groups used the same anesthesia induction program, the observation group was given intravenous infusion of dexmedetomidine before anesthesia induction, while the control group was received intravenous infusion of saline. And the patient- controlled intravenous analgesia was given in two groups. Recorded the systolic blood pressure(SBP), diastolic blood pressure(DBP), pulse oxygen saturation(SPO₂) and heart rate(HR)in two groups at below time points: before anesthesia induction(T0), 1 min after intubation(T1), 5 min after intubation(T2), 1 h after extubation(T3)and right after the surgery completed(T4). Compared the pain and sedation status between the two groups right after extubation. Recorded the recovery time of orientation, wake-up time, extubation time,dosage of morphine and adverse reactions of two groups. Results: SBP and DBP levels in two groups at T1 were significantly decreased than T0, and the SBP in control group at T3 was higher than T0, the differences were statistically significant(P<0.05); The SBP and DBP levels in observation group at T1 were higher than the control group, and the SBP at T3 was lower than the control group, the differences were statistically significant(P<0.05); The HR level in observation group at T1, T2, T3, T4 were significantly higher than the control group respectively, the differences were statistically significant (P<0.05); The visual analogue scale(VAS) score in the observation group was lower than control group, and Ramasy score higher than the control group right after extubation, the differences were statistically significant(P<0.05). The dosage of morphine in the observation group was significantly lower than that in the control group, the difference was statistically significant (P<0.05), while the recovery time of orientation, wake-up time, extubation time and adverse reactions of two groups had no statistical difference(P>0.05). Conclusion: Using dexmedetomidine combined with propofol has little effect on hemodynamics in patients with lumbar surgery, analgesic and sedative effect significantly, with small dosage of postoperative analgesic drugs, which is worthy of promotion.