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1、探讨右美托咪定不同给药方式对下肢骨科术后镇痛效应的影响大庆油田总医院163000目的研究分析右美托咪定(Dex)不同给药方式对K肢骨科术后镇痛效应和不良反应的影响。方法此次研究的对象是选择行下肢骨科手术患者60例,将其临床资料进行回顾性分析,并采用腰硬联合麻醉,术后硬膜外镇痛。随机分为3组(每组20例),M组:吗啡5mg+0.2%罗哌卡因+生理盐水至lOOrnL;D1组:在手术结束前缓慢静注(lOmin)Dex0.8μg/kg,硬膜外配泵,吗啡2mg+0.2%罗哌卡因+生理盐水至lOOmL;D2组:Dex0.8μg/kg+吗啡2mg+0
2、.2%罗哌卡因+生理盐水至lOOmL;3组均为4mL/h的背景输入量。记录PCEA开始后6、12、24h的VAS镇痛评分、Ramsay镇静评分、平均动脉压(MAP)、心率(HR)变化,并观察恶心、呕吐、皮肤瘙痒等不良反应发生情况。结果硬膜外镇痛(PCEA)各时点3组的VAS评分和Ramsay评分差异无统计学意义(P>0.05);D1组MAP明显低于D2组、M组(P<0.05);D1组在心动过缓发生率明显低于D2组、M组(P<0.05);D1组、D2组在24h内恶心、呕吐、皮肤瘙痒不良反应发生率明显低于M组(P<0.05)。结
3、论Dex用于硬膜外配泵方式给药术后镇痛、镇静效果确切,可以减少吗啡用量,血流动力学平稳,不良反应较少。关键词:右美托咪定;给药方式;术后镇痛[Abstract]ObjectiveTostudytheanalysisofdexmedetomidine(DEX)indifferentadministrationmethodsoneffectsofanalgesiceffectandadversereactionoflowerextremityafterorthopedicsurgery.Methodsthestudywasconductedin60pa
4、tientswithlowerlimbsurgeryinthelowerextremity,theclinicaldatawereretrospectivelyanalyzed,combinedwithspinalepiduralanesthesia,postoperativeepiduralanalgesia.Randomizedtothreegroups(n=20),groupM:morphine5mg+0.2%ropivacaine+normalsalineto100ml;DIgroup:beforetheendofsurgeryslowin
5、travenousinjection(10min)DEX0.8g/kg,epiduralpump,morphine2mg+0.2%ropivacaine+normalsalineto100ml;groupD2:DEX0.8mug/kg+morphine2mg+0.2%ropivacaine+normalsalinetolOOml.Threegroupswerefor4mL/hbackgroundinput.TheVASanalgesiascore,Ramsaysedationscore,meanarterialpressure(MAP)andhea
6、rtrate(HR)wererecordedandtheadversereactionssuchasnausea,vomiting,skinitchingandotheradversereactionswereobservedafterthestartofPCEA6,12,24h.Resultsepiduralanalgesia(PCEA)ateachtimepointinthreegroupsofVASscoreandRamsayscoredifferencehadnostatisticalsignificance(P>0.05);mapi
7、nDIgroupwassignificantlylowerthanthatoftheD2group,Mgroup(P<0.05);groupDIinbradycardiaincidencewassignificantlylowerthanthatingroupD2,Mgroup(P<0.05);groupDIandD2nauseawithin24h,vomiting,skinitchingandadversereactionsoccurredwerelowerthanthoseinMgroup(P<0.05).Conclusion
8、Dexcanbeusedforepiduralanalgesiaandsedationafterepiduralanest