CAJ | 학술논문

目的：探讨不同方式给予右美托咪定对腰丛联合坐骨神经阻滞下老年患者下肢手术中镇静和血流动力学的影响。方法单侧下肢手术老年患者80例，年龄60～85岁，ASA分级Ⅰ～Ⅲ级，随机分为四组（每组20例）：右美托咪定诱导量0．5μg／kg，静脉输注15 min，0．3μg／（kg·h）维持（D1组）；右美托咪定按0．5μg／（kg·h）剂量持续输注至术毕（D2组）；咪达唑仑诱导量0．015 mg／kg，静脉输注15 min，0．1 mg／（kg·h）维持（M组）及等量生理盐水组（C组）。在麻醉前（T0）、静脉给药即刻（T1）、静脉给药15 min（T2）、30 min（T3）和术毕（T4）时各时间点分别测定MAP、HR、SpO2和脑电双频指数（BIS）值，并进行OAA／S镇静评分。结果与C组和T0比较，镇静评分在D1和M组的T2、T3、T4和D2组的T4时间点较低，BIS值在D1和M组的T2、T3、T4及D2组的T3、T4时间点较低（P ＜0．05）；与D1组和T0时间点比较，MAP在C和M组的T2、T3、T4及D2组的T2时间点升高（P ＜0．05）；与C、M组和T0时间点比较，HR在D1组的T2、T3、T4和D2组的T3、T4时间点降低（P＜0．05）。结论对于腰丛联合坐骨神经阻滞下行下肢手术的老年患者，给予一定诱导剂量后持续输注右美托咪定可使患者较快达到镇静状态，且血流动力学平稳。
목적：탐토불동방식급여우미탁미정대요총연합좌골신경조체하노년환자하지수술중진정화혈류동역학적영향。방법단측하지수술노년환자80례，년령60～85세，ASA분급Ⅰ～Ⅲ급，수궤분위사조（매조20례）：우미탁미정유도량0．5μg／kg，정맥수주15 min，0．3μg／（kg·h）유지（D1조）；우미탁미정안0．5μg／（kg·h）제량지속수주지술필（D2조）；미체서륜유도량0．015 mg／kg，정맥수주15 min，0．1 mg／（kg·h）유지（M조）급등량생리염수조（C조）。재마취전（T0）、정맥급약즉각（T1）、정맥급약15 min（T2）、30 min（T3）화술필（T4）시각시간점분별측정MAP、HR、SpO2화뇌전쌍빈지수（BIS）치，병진행OAA／S진정평분。결과여C조화T0비교，진정평분재D1화M조적T2、T3、T4화D2조적T4시간점교저，BIS치재D1화M조적T2、T3、T4급D2조적T3、T4시간점교저（P ＜0．05）；여D1조화T0시간점비교，MAP재C화M조적T2、T3、T4급D2조적T2시간점승고（P ＜0．05）；여C、M조화T0시간점비교，HR재D1조적T2、T3、T4화D2조적T3、T4시간점강저（P＜0．05）。결론대우요총연합좌골신경조체하행하지수술적노년환자，급여일정유도제량후지속수주우미탁미정가사환자교쾌체도진정상태，차혈류동역학평은。
Objective To investigate the effects of different dexmedetomidine administrations onsedation and hemodynamics during combined lumbar plexus and sciatic nerve blocks in elderly patients undergoing unilateral lower limb surgery.Methods Eighty ASAⅠor Ⅲ patients,aged 60 ~85 years,received lower limb surgery and were randomly divided into four groups(n =20 in each group).Patients received 0.5 μg/kg of dexmedetomidine induction for 15 min and 0.3 μg/(kg·h)of dexmedetomidine forcontinuous infusion in group D1 ,0.5 μg/(kg·h)of continuous dexmedetomidine infusion in group D2,0.015 mg/kg of midazolam induction for 15 min and 0.2 mg/(kg·h)of continuous midazolam infusion ingroup M,and equal volume of normal saline in group C.The mean arterial pressure(MAP),heart rate(HR),SpO2 ,OAA/S scores and bispectral index(BIS)values were recorded before the anesthesia(T0 ),atthe time of intravenous administration(T1 ),15 min after intravenous administration(T2 ),30 min after intravenous administration(T3 )and the end of operation(T4).Results Compared with group C at T0 ,OAA/S scores were lower in group D1 and group Mat the time of T2 ,T3 and T4 and group D2 at the timeof T4(P <0.05).BIS values were lower in group D1 and group Mat the time of T2 ,T3 and T4 and groupD2 at the time of T3 and T4 (P <0.05).Compared with group D1 at T0,MAP was increased in group C andgroup Mat the time of T2 ,T3 and T4 and group D2 at the time of T2 (P <0.05).Compared with group Cand group Mat T0,HR was decreased in group D1 at the time of T2 ,T3 and T4 and group D2 at the time ofT3 and T4 (P <0.05).Conclusion Certain doses of dexmedetomidine induction followed by continuousinfusion can provide rapid sedation and stable hemodynamics in elderly patients undergoing lower limb surgery during combined lumbar plexus and sciatic nerve blocks.