布比卡因单独或联合右美托咪定腰麻用于全膝关节置换术的剂量-效应关系

摘要/Abstract

摘要： 目的确定布比卡因(Bup)单独或联合右美托咪定(Dex)腰麻用于全膝关节置换术(TKA)的剂量-效应关系。方法 ASAⅠ~Ⅱ、CSEA下行TKA患者162名,随机分为B组、BD1组及BD2组,每组54名。按Bup腰麻剂量(6~11 mg)不同,再分为6个亚组,注入不同剂量Bup、Bup联合 2 μg 或 4 μg Dex。成功麻醉标准为腰麻后 15 min 内感觉平面阻滞达T₁₂、运动神经阻滞完善;有效抑制止血带疼痛反应标准为上止血带期间无疼痛感受。以Probit法计算单独或联合不同剂量Dex成功麻醉及有效抑制止血带疼痛反应Bup腰麻的ED₅₀及ED₉₅。结果三组患者麻醉成功率相似。BD1组及BD2组开始术后镇痛时间明显晚于B组;B组、BD1组、BD2组成功麻醉Bup腰麻的 ED₅₀及ED₉₅相似;BD1组、BD2组有效抑制止血带疼痛反应的 ED₅₀分别为 5.5 mg、5.3 mg,低于B组的 7.2 mg(P<0.05);ED₉₅分别为 8.2 mg、7.9 mg,低于B组的 9.9 mg(P<0.05)。结论蛛网膜下隙注入 2 μg 或 4 μg Dex对TKA患者成功麻醉Bup腰麻的ED₅₀、ED₉₅没有影响,但能明显降低有效抑制止血带疼痛反应Bup的ED₅₀、ED₉₅。

关键词: 布比卡因, 右美托咪定, 腰麻, 止血带, 疼痛, 剂量-效应关系

Abstract: AIM: To determine the dose-effect relationship of intrathecal bupivacaine (Bup) co-administered with dexmedetomidine (Dex) for total knee arthroplasty (TKA). METHODS: One hundred Sixty-two ASAⅠ-Ⅱ patients undergoing TKA with use of CSEA were enrolled in this study. Patients were randomely assigned into three groups: Group B (Bup), Group BD1 (Bup plus 2 μg Dex) and Group BD2 (Bup plus 4 μg Dex). Each group was further divided by Bup doses of 6-11 mg. Successful anesthesia and successful tourniquet pain blockade were defined. The ED₅₀ and ED₉₅ values for successful anesthesia and successful tourniquet pain blockade were determined separately by Probit regression analysis. RESULTS:The rate of successful anesthesia was not different among three groups. The time of start postoperative analgesia in Group BD1, Group BD2 was later than that in Group B (P=0.036), respectively. The rate of successful tourniquet pain blockade was different among three groups. The ED₅₀ and ED₉₅ values for successful tourniquet pain blockade were significantly smaller in Group BD1 and BD2 than that in Group B (P<0.05). CONCLUSION: Intrathecal Dex did not decrease the dose of intrathecal Bup required for successful anesthesia for patients undergoing TKA. However, it reduced the dose required for tourniquet pain blockade.

Key words: bupivacaine, dexmedetomidine, spinal anesthesia, tourniquet, pain, dose-effect relationship

中图分类号:

R733

徐燕, 袁力勇. 布比卡因单独或联合右美托咪定腰麻用于全膝关节置换术的剂量-效应关系[J]. 中国临床药理学与治疗学, 2014, 19(7): 789-794.

XU Yan, YUAN Li-yong. The dose-effect relationship of intrathecal bupivacaine co-administered with dexmedetomidine for total knee arthroplasty[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(7): 789-794.

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