2019 年第 7 期 第 14 卷

右美托咪定复合舒芬太尼应用于经皮椎间孔镜手术的临床效果

Clinical effect of dexmedetomidine combined with sufentanil on percutaneous transforaminal endoscopic discectomy

作者：郭浩李志山王治陈强

英文作者：

单位：030001太原，山西省人民医院麻醉科

英文单位：

关键词：经皮椎间孔镜手术；右美托咪定；舒芬太尼；镇静

英文关键词：

• 摘要：

• 【摘要】目的    观察并评价右美托咪定复合舒芬太尼应用于经皮椎间孔镜手术的临床效果。方法    选择2016年3—12月在山西省人民医院行经皮椎间孔镜手术的患者60例。按照随机数字表法，分为3组，各20例。A组行2%利多卡因局部浸润麻醉；B组行2%利多卡因局部浸润+静脉注射芬太尼、咪达唑仑麻醉；C组2%利多卡因局部浸润+静脉注射舒芬太尼、泵注右美托咪定麻醉。分别记录患者入室给药前（T0）、手术开始时(T1)、打磨小关节时(T2)、神经松解时(T3)、术毕(T4)的收缩压、舒张压、心率及脉搏血氧饱和度（SpO2）的变化，各个时刻3组患者的镇静评分（Ramsay），患者和手术医师的满意度评分，以及术中不良反应及并发症。结果    与T0时比较，A组收缩压、舒张压、心率在T2～T4均明显增加（P<0.05），C组心率在T1～T4明显降低（P<0.05）。与A组比较，B组、C组收缩压、舒张压、心率在T2～T4均明显降低（P<0.05）。与B组比较，C组心率在T1～T4明显降低（P<0.05）。B组、C组镇静评分、患者满意度评分以及手术医师满意度评分均高于A组［（3.6±0.6）、（3.3±0.8）分比（1.2±0.4）分，9(8,9)、9（9，9）分比4（3，4）分，8（6，8）、9（9，9）分比5（4，5）分］，差异均有统计学意义（均P<0.05）。结论    右美托咪定复合舒芬太尼可以安全应用于经皮椎间孔镜手术。在满足手术需要的同时，大大提高了患者及手术医师的满意度，为麻醉药物的选择提供了新的思路。

• 【Abstract】Objective    To observe the clinical effect of dexmedetomidine combined with sufentanil on percutaneous transforaminal endoscopic discectomy(PTED). Methods    Sixty patients undergoing PTED in Shanxi Provincial People′s Hospital from March to December 2016 were randomly divided into 3 groups, with 20 cases in each group. Group A underwent local infiltration anesthesia with 2% lidocaine; group B underwent local infiltration with 2% lidocaine plus intravenous fentanyl and midazolam; group C underwent local infiltration with 2% lidocaine plus intravenous sufentanil and dexmedetomidine. Changes of systolic blood pressure, diastolic blood pressure, heart rate, pulse oxygen saturation(SpO2) and Ramsay sedation score were monitored before anaesthetic drug administration(T0), at the beginning of operation(T1), during small joint polishing(T2), during neurolysis(T3) and at the end of operation(T4). Satisfaction scores of patients and doctors, intraoperative adverse reactions and postoperative complications were recorded. Results    Compared with T0, systolic blood pressure, diastolic blood pressure and heart rate in group A significantly increased during T2-T4(P<0.05); heart rate in group C significantly decreased during T1-T4(P<0.05). During T2-T4, systolic blood pressure, diastolic blood pressure and heart rate in group B and C were significantly lower than those in group A(P<0.05). During T2-T4, heart rate in group C was significantly lower than that in group B(P<0.05). Ramsay sedation score, satisfaction scores of patients and doctors in group B and group C were significantly higher than those in group A［（3.6±0.6）,（3.3±0.8） vs （1.2±0.4）; 9（8,9）, 9(9,9) vs 4(3,4); 8(6,8), 9(9,9) vs 5(4,5)］(P<0.05). Conclusion    Dexmedetomidine combined with sufentanil anesthesia can be safely applied to PTED.