右美托咪定复合丙泊酚全麻在腰椎管减压、椎弓根钉内固定植骨、融合术中的应用

目的:观察右美托咪定复合丙泊酚全麻在腰椎管减压、椎弓根钉内固定植骨融合术中的应用价值。方法:将2015年7月至2019年8月于我院手术治疗84例腰椎退行性疾病患者按随机数字表法分为观察组和对照组,每组42例。观察组于麻醉诱导前静脉泵入0.5μg/kg右美托咪定并在术中以0.2μg/kg·h麻醉维持,对照组于麻醉诱导前静脉泵入生理盐水。对比两组麻醉诱导前(T0)、诱导后(T1)、插管后1 min(T2)和5 min(T3)、拔管1 min(T4)和5 min(T5)的心率(HR)、收缩压(SBP)及舒张压(DBP)的数值,同时记录患者的手术时间、苏醒时间、瑞芬太尼用量及12 h内吗啡用量。比较各时间点VAS评分及不良反应的发生率。结果:与T0比较,两组患者T1时HR、SBP、DBP均显著降低(P<0.05),与T1比较,两组患者T2、T3和T4时HR、SBP、DBP均显著升高(P<0.05),观察组在T3、T4和T5时HR、SBP、DBP均显著降低(P<0.05)。观察组患者各时间点VAS评分及瑞芬太尼用量和24 h吗啡用量均显著低于对照组(P<0.05),观察组患者不良反应发生率显著低于对照组(P<0.05)。结论:右美托咪定复合丙泊酚全麻能够维持术中血液动力学稳定,减少术中麻醉药物和术后镇痛药物用量,改善术后镇痛效果,且不良反应少。

Application of Dexmedetomidine Combined with Propofol General Anesthesia in the Lumbar Spinal Canal Decompression and Pedicle Screw Fixation and Fusion

Objective:To observe the application value of dexmedetomidine combined with propofol general anesthesia in the lumbar spinal canal decompression and pedicle screw fixation and fusion.Methods:A total of 84 patients with lumbar degenerative diseases treated with surgery in the hospital between July 2015 and August 2019 were divided into the observation group and the control group by the random number table method,with 42 cases in each group.Patients in the observation group were treated with intravenous pumping of 0.5μg/kg dexmedetomidine before anesthesia induction and maintenance of anesthesia with 0.2μg/kg·h during operation,while those in the control group were treated with intravenous pumping of normal saline before anesthesia induction.Comparisons of heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)between the 2 groups were made before anesthesia induction(T0),after induction(T1),1 min(T2)and 5 min(T3)after intubation,1 min(T4)and 5 min(T5)after extubation.Meanwhile,the operation time,recovery time,dosage of remifentanil and dosage of morphine within 12 h were recorded.VAS scores at different time points and the incidence of adverse reactions were compared.Results:Compared with T0,the HR,SBP and DBP of both groups were significantly decreased at T1(P<0.05).Compared with T1,the HR,SBP and DBP of both groups were significantly increased at T2,T3 and T4(P<0.05).The HR,SBP and DBP of the observation group were significantly decreased at T3,T4 and T5(P<0.05).VAS scores of the observation group at different time points and dosages of remifentanil and morphine in 24 h were significantly lower than those in the control group(P<0.05),and the incidence of adverse reactions in the observation group was also significantly lower than that in the control group(P<0.05).Conclusion:Dexmedetomidine combined with propofol general anesthesia can maintain intraoperative hemodynamic stability,reduce the intraoperative dosage of anesthetics and postoperative dosage of analgesics,and improve the postoperative analgesic effect,with few adverse reactions.