高龄患者椎管内麻醉应用右美托咪定的镇静效果观察

汪利兴

[摘要] 目的 分析高齡患者椎管内麻醉应用右美托咪定的镇静效果。 方法 将2018年1月～2019年1月期间我院收治的100例椎管内麻醉高龄患者作为研究对象，随机分为观察组和对照组各50例，对照组静脉泵注0.9%氯化钠注射液，观察组静脉泵注右美托咪定。对比两组患者不同时间段收缩压、呼吸频率及心率方面的变化，分析两组患者的镇静效果以及不良反应发生率。 结果 在麻醉前，两组患者心率、呼吸频率以及收缩压等血流动力学指标数据比较差异较小（P>0.05），在麻醉后，观察组患者的心率以及收缩压显著低于对照组，对比有统计学意义（P<0.05），两组呼吸频率无显著变化;麻醉前，两组Ramsay评分无明显差异（P>0.05），麻醉后，观察组评分显著优于对照组，对比有统计学意义（P<0.05）;观察组并发症发生率显著低于对照组，对比有统计学意义（P<0.05）。 结论 对高龄患者使用右美托咪定进行椎管内麻醉能够取得理想的麻醉效果，有助于维持患者血流动力学稳定，降低患者不良反应发生率，安全性高，使用价值高，值得推广。

[关键字] 高龄患者;椎管内麻醉;右美托咪定;镇静效果

[中图分类号] R614          [文献标识码] B          [文章编号] 1673-9701（2020）16-0124-04

Observation of the sedative effect of dexmedetomidine on elderly patients undergoing intraspinal anesthesia

WANG Lixing

Department of Anesthesiology， Peoples Hospital Affiliated to Fujian University of Traditional Chinese Medicine， Fuzhou   350004， China

[Abstract] Objective To analyze the sedative effect of dexmedetomidine on elderly patients undergoing intraspinal anesthesia. Methods 100 elderly patients undergoing intraspinal anesthesia admitted to our hospital from January 2018 to January 2019 were selected as the subjects of research and randomly divided into the observation group and the control group with 50 patients in each group. The control group received 0.9% sodium chloride through intravenous pumping and the observation group received dexmedetomidine through intravenous pumping. The changes of systolic blood pressure（SBP）， respiratory frequency and heart rate in different time periods of the two groups of patients were compared， and the sedative effect and incidence of adverse reactions（ADRs） of the two groups of patients were analyzed. Results Before anesthesia， there was no statistically significant difference between the two groups in the hemodynamic indexes such as heart rate， respiratory frequency and SBP（P>0.05）. After anesthesia， the heart rate and SBP of the patients in the observation group were significantly lower than those in the control group， with statistical significance of comparison（P<0.05）， and the respiratory frequency of the two groups showed no significant changes. Before anesthesia， there was no significant difference in Ramsay scores between the two groups（P>0.05）; after anesthesia， the Ramsay scores of the observation group were significantly superior to those of the control group， and the comparison was statistically significant（P<0.05）. The incidence of the complications in the observation group was significantly lower than that in the control group， and the comparison was statistically significant（P<0.05）. Conclusion The use of dexmedetomidine in intraspinal anesthesia for elderly patients can achieve ideal anesthesia effect， which is helpful for maintaining the hemodynamic stability of the patients and reducing the incidence of their ADRs. With sound safety and much application value， it is worthy of promotion.

[Key words] Elderly patients; Intraspinal anesthesia; Dexmedetomidine; Sedative effect

椎管内麻醉主要是将麻醉药物注入到椎管蛛网膜下腔和硬膜外腔，使脊神经根阻滞，使其所支配的相应区域取得理想的麻醉效果[1]。该麻醉方式在外科麻醉手术中较为常见，能够使患者在镇痛时保持清醒，有助于术中及时与患者进行沟通，明确患者在术中的不适，提高手术的安全性。但因多数高龄患者机体功能逐渐降低，耐受力以及心理承受压力较差，术前容易发生紧张、焦躁以及不安等不良情绪，导致患者在术中的心率加快，血压升高，影响手术顺利进行，对此，必须要做好术前麻醉镇静工作。而右美托咪定是临床常见的一种麻醉药物，具有理想的镇静效果，能够促使手术顺利进行[2]。本次……