作　　者： (杨经文）; (刘卫华）; ;

机构地区： 暨南大学

出　　处： 《岭南现代临床外科》 2017年第5期547-550,共4页

摘　　要： 目的探讨右美托咪定静脉给药和硬膜外给药对利多卡因硬膜外阻滞EC_(50)的影响。方法择期行硬膜外麻醉的下肢及下腹部手术患者75例,年龄20~51岁,体重45~71 kg,ASA分级Ⅰ~Ⅱ级,随机将其分为对照组(利多卡因15 mL硬膜外注射,n=25),右美静脉组(利多卡因15 mL硬膜外注射,右美托咪定0.5μg/kg外周静脉泵入,n=25),右美硬膜外组(利多卡因混合右美托咪定0.5μg/kg 15 mL硬膜外注射,n=25)。采用硬膜外麻醉,腰椎2/3间隙穿刺置管成功后,各组分别注入利多卡因或利多卡因右美托咪定混合液15 mL,采用序贯法测定各组利多卡因硬膜外阻滞皮肤钳夹的半数有效浓度(EC_(50))。观察各组患者麻醉前、麻醉后10 min和20 min Ramsay评分,以及不良反应的发生情况。结果三组利多卡因的EC_(50)及95%CI分别为1.39±0.12μg/mL(95%CI:1.29,1.49),1.35±0.14μg/mL(95%CI:1.23,1.47),0.79±0.05μg/mL(95%CI:0.75,0.84),右美硬膜外组与对照组和右美静脉组相比,EC_(50)明显下降,差异有统计学意义(P<0.05);右美静脉组与对照组相比EC_(50)下降差异无统计学意义(P>0.05)。在麻醉后10 min、20 min右美静脉组与对照组和右美硬膜外组比较,Ramsay评分升高(P<0.05);在麻醉后10 min、20 min右美硬膜外组与对照组比较,Ramsay评分升高(P<0.05),但升高没有右美静脉组明显。三组MAP、HR、SpO_2比较差异无统计学意义(P>0.05)。结论右美托咪定硬膜外注射可降低利多卡因硬膜外阻滞的EC_(50),其可能通过脊神经局部阻滞起到镇痛作用。 Objective To evaluate the effect of different route of administration of dexmedetomi?dine(DEX)between intravenous versus epidural injection on median effective concentration(EC50)of lidocaine for epidural block.Methods75ASAⅠorⅡpatients aged20~51years,weighty45~71kg,scheduled for lower extremity or lower abdomen surgery under epidural block were randomly divided into3groups(n=25in each):Control Group(lidocaine15ml epidural injection),Intravenous DEX Group(lidocaine15ml epidural injection with0.5μg/kg intravenous dexmedetomidine),Epidural DEX Group(lidocaine combined with0.5μg/kg dexmedetomidine15mL epidural injection).Up?and?down method was used to measure EC50of lidocaine in each group.Mean artery pressure(MAP),heart rate(HR),oxygen saturation(SpO2),Ramsay score and adverse events were recorded at the same time.Results The EC50and95%CI of lidocaine were1.39±0.12μg/mL(95%CI:1.29,1.49),1.35±0.14μg/mL(95%CI:1.23,1.47),0.79±0.05μg/mL(95%CI:0.75,0.84)in the three groups separately.EC50of lidocaine in Epidural DEX Group was decreased significantly compared with those in the Control Group and the Intravenous DEX Group(P<0.05),but there was no significant difference between the Intravenous DEX Group and the Control Group.Ramsay score was increased significantly in the Intravenous DEX Group compared with those in the Control Group and the Epidural DEX Group,Ramsay score in the Intravenous DEX Group was higher than that in the Epidural DEX Group significantly(P<0.05).There was no significant difference between the3groups in MAP,HR and SpO2.Conclusion Epidural injection of Dexmedetomidine can significantly decrease the EC50of lidocaine for epidural block and it might have anaesthetic effect on spinal nerve.

关 键 词： 右美托咪定 利多卡因 给药途径

领　　域： [医药卫生—治疗学] [医药卫生—临床医学]