麻醉深度指数(AI)引导下丙泊酚与右美托咪定用于关节置换患者镇静效果的比较

Comparison of Sedative Effect of Propofol and Dexmedetomidine Guided by AI in Patients Undergoing Joint Replacement

摘要: 目的：探索比较在腰硬联合麻醉下，使用麻醉深度指数(AI)监测右美托咪定和丙泊酚二者的镇静效果、血流动力学改变以及相关不良反应发生的情况。方法：腰硬联合麻醉下行关节置换的患者60例，性别不限，年龄55~80岁，ASA分级为I~II级。术中使用麻醉深度指数(AI)和警觉/镇静评分(OAA/S评分)监测丙泊酚或右美托咪定的镇静深度。采用随机对照试验的方法，将进行腰硬联合麻醉的患者随机分为2组：丙泊酚组(A组)、右美托咪定组(B组)。选择L_2-3或L_3-4椎间隙进行穿刺，给予腰硬联合麻醉，调节麻醉平面在T₁₀-S₅。平面固定后，摆好手术体位，A组静脉注射丙泊酚2 mg∙kg⁻¹，维持剂量1~2 mg∙kg⁻¹∙h⁻¹，直至手术结束前15 min停药；B组静脉泵注0.75 ml∙kg⁻¹∙h⁻¹右美托咪定(4 ug∙ml⁻¹) 15 min，维持剂量0.2 ml∙kg⁻¹∙h⁻¹，直至手术结束前15 min停药。AI值控制在60~90。记录麻醉平面固定后、输注丙泊酚或右美托咪定前(T₀)、破皮(T₁)、打假体(T₂)、注入骨水泥(T₃)、手术结束(T₄)时的警觉/镇静评分(OAA/S评分)。记录术中低血压、心动过缓、呼吸抑制及恶心呕吐等不良反应的发生情况。结果：与A组相比，T1-4时B组的OAA/S评分更低，心动过缓发生率升高，呼吸抑制发生率降低(P < 0.05)，低血压和恶心呕吐的发生率差异无统计学意义(P > 0.05)。结论：当AI值在60~90时，通过腰硬联合麻醉进行关节置换手术的患者，右美托咪定的镇静效果优于丙泊酚，在血流动力学的稳定性上更具优势，不良反应更少，安全性更高，但要防止心动过缓的发生。

Abstract: Objective: To explore and compare the sedative effect, hemodynamic changes and related adverse reactions of dexmedetomidine and propofol under combined spinal epidural anesthesia (AI). Methods: Sixty patients with joint replacement under combined spinal epidural anesthesia, regardless of gender, aged 55~80 years, ASA grade I~II. Anesthesia depth index (AI) and alertness/sedation score (OAA/S score) were used to monitor the sedation depth of propofol or dexmedetomidine. The patients undergoing combined spinal epidural anesthesia were randomly divided into two groups: propofol group (group A) and dexmedetomidine group (group B). Select L_2-3 or L_3-4 intervertebral space for puncture, give combined spinal epidural anesthesia, and adjust the anesthesia plane at T₁₀-S₅. Group A received intravenous injection of propofol 2 mg∙kg⁻¹ at a dose of 1~2 mg∙kg⁻¹∙h⁻¹ until 15 minutes before the end of the operation; In group B, dexmedetomidine 0.75 ml∙kg⁻¹∙h⁻¹ (4 ug∙ml−1) was infused intravenously for 15 minutes, and the maintenance dose was 0.2 ml∙kg⁻¹∙h⁻¹ until the end of operation. AI value is controlled between 60 and 90. The OAA/s scores were recorded after anesthesia plane fixation, before propofol or dexmedetomidine infusion (T₀), skin breaking (T₁), prosthesis implantation (T₂), bone cement injection (T3) and at the end of operation (T₄). The incidence of hypotension, bradycardia, respiratory depression, nausea and vomiting were recorded. Results: Compared with group A, the OAA/s score of group B at T_1-4 was lower, the incidence of bradycardia was higher, the incidence of respiratory depression was lower (P < 0.05), the incidence of hypotension and nausea and vomiting had no significant difference (P > 0.05). Conclusion: When the AI value is 60~90, the sedative effect of dexmedetomidine is better than that of propofol in patients undergoing joint replacement under combined spinal epidural anesthesia. Dexmedetomidine has more advantages in hemodynamic stability, fewer adverse reactions and higher safety, but bradycardia should be prevented.