CAJ | 학술논문

目的比较右美托咪定(dexmedetomidine,Dex)和可乐定硬膜外给药对罗哌卡因阻滞效果的影响. 方法全组75例患者美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄55岁～65岁,拟行阴式子宫切除术.按随机数字表法分为硬膜外给予0.75％罗哌卡因15 ml含100 μg Dex组(RD组)、硬膜外给予0.75％罗哌卡因15ml含100 μg可乐定组(RC组)和硬膜外给予0.75％罗哌卡因15ml含生理盐水组(C组). 结果 RD组麻醉平面到达T10起效时间[(8.5±2.4)min]短于RC组和C组[(10.4±3.4) min和(12.7±4.3)min],RD组在较短的时间内[(13±4)min]达到最高阻滞平面,明显短于RC组和C组[(15±4) min和(18±4) min];RD组完全运动阻滞时间[(18±5)min]短于RC组和C组[(21±4) min和(24±4)min；(P＜0.05和P＜0.01)].RD组术后24 h曲马多用量[(87±17)mg]也显著少于RC组和C组[(101±21) mg和(146±19) mg;(P＜0.01)].RD组和RC组寒战发生率明显低于C组(P＜0.01),未发现1例呼吸抑制. 结论硬膜外给予Dex可增强罗哌卡因硬膜外阻滞效果,与可乐定比较麻醉起效快、围术期呼吸循环稳定,减少术后镇痛药的应用.
목적 비교우미탁미정(dexmedetomidine,Dex)화가악정경막외급약대라고잡인조체효과적영향. 방법 전조75례환자미국마취의사협회(ASA)분급Ⅰ혹Ⅱ급,년령55세～65세,의행음식자궁절제술.안수궤수자표법분위경막외급여0.75％라고잡인15 ml함100 μg Dex조(RD조)、경막외급여0.75％라고잡인15ml함100 μg가악정조(RC조)화경막외급여0.75％라고잡인15ml함생리염수조(C조). 결과 RD조마취평면도체T10기효시간[(8.5±2.4)min]단우RC조화C조[(10.4±3.4) min화(12.7±4.3)min],RD조재교단적시간내[(13±4)min]체도최고조체평면,명현단우RC조화C조[(15±4) min화(18±4) min];RD조완전운동조체시간[(18±5)min]단우RC조화C조[(21±4) min화(24±4)min；(P＜0.05화P＜0.01)].RD조술후24 h곡마다용량[(87±17)mg]야현저소우RC조화C조[(101±21) mg화(146±19) mg;(P＜0.01)].RD조화RC조한전발생솔명현저우C조(P＜0.01),미발현1례호흡억제. 결론 경막외급여Dex가증강라고잡인경막외조체효과,여가악정비교마취기효쾌、위술기호흡순배은정,감소술후진통약적응용.
Objective The aim of this study was to evaluate the efficacy of epidural dexmedetomidine (Dex) and clonidine on ropivacaine epidural anesthesia.Methods Seventy-five patients ASA Ⅰ or Ⅱ,aged 55 y-65 y,scheduled for elective vaginal hysterectomy under epidural anesthesia with ropivacaine were randomly allocated into three groups:patients in group RD were administered 15 ml of 0.75％ epidural ropivacaine and 100 μg of Dex,while group RC received admixture of 15 ml of 0.75％ropivacaine and 100 μg of clonidine,and group C received 15 ml of 0.75％ ropivacaine and saline.Results The patient in group RD exhibited an earlier onset of sensory analgesia at T10 [(8.5±2.4) min] as compared to group RC and group C [(10.4±3.4) min and (12.7±4.3) min].Dex not only provided a higher dermatomal spread but also helped in achieving the maximum sensory anaesthetic level in a shorter period [(13±4) min compared to clonidine (15±4) min and (18±4) min].Bromage scale 3 was achieved earlier in group RD [(18±5) min] than in group RC and group C [(21±4) min and (24±4) min,P＜0.05].Less tramadol consumed in group RD [(87±17) mg] than that in group RC and in group C [(101±21) min and (146±19) mg,P＜0.01] for postoperative analgesia of 24 h(P＜0.05).Sedation scores in group RD and group RC were better than in group C(P＜0.05).The incidence of shivering was lower in group RD and group RC than that in group C (P＜0.05).Respiratory depression was not observed in each group.Conclusions Epidural Dex may reinforce the effect of epidural anaesthesia with ropivacaine and analgesia.Dex is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia,stable cardio-respiratory parameters and a prolonged post-operative analgesia.