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低剂量右美托咪定延长老年患者脊髓麻醉的效果：一项前瞻性随机对照研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：田明德 编辑：田明德 审校：曹莹
背景：经尿道前列腺切除术（TURP）的脊髓麻醉持续时间短，这给术后疼痛管理带来了挑战。本研究旨在探讨0.4µg/kg右美托咪定静脉滴注对老年TURP患者延长脊髓麻醉时间和减轻术后疼痛的作用。
方法：这项前瞻性随机对照试验招募了38名年龄在60-80岁之间进行择期TURP手术和脊髓麻醉的患者。将患者随机分为两组：D组给予0.4µg/kg右美托咪定静脉注射，C组在脊髓麻醉后给予生理盐水静脉注射。主要观察指标为2-皮区回归时间。
结果：2-皮区回归时间D组明显长于C组（104.44±16.97 min∶80.63±15.59 min, p < 0.05）。D组[T7 (T6-T8)]的感觉阻滞峰值水平显著高于C组[T10 (T7-T10)] （p = 0.017）。两组在0、6、12、24 h的低血压、心动过缓及术后疼痛发生率无差异。
结论：静脉注射0.4µg/kg右美托咪定显著延长脊髓感觉阻滞持续时间。虽然术后镇痛没有不同，但在不增加副作用的情况下提供了血流动力学稳定性。
原始文献来源：Sangkum L, Termpornlert S, Tunprasit C, Rathanasutthajohn C, Komonhirun R, Dusitkasem S. Effect of low-dose dexmedetomidine to prolong spinal anesthesia in elderly patients: a prospective randomized controlled study. BMC Anesthesiol. 2024;24(1):427. Published 2024 Nov 26.
Effect of low-dose dexmedetomidine to prolong spinal anesthesia in elderly patients: a prospective randomized controlled study
Abstract
Background: Spinal anesthesia for transurethral resection of the prostate (TURP) has a short duration, which poses challenges for postoperative pain management. The present study aimed to investigate the effects of intravenous (IV) dexmedetomidine at a dosage of 0.4 µg/kg in prolonging the duration of spinal anesthesia and minimizing postoperative pain in elderly patients undergoing TURP.
Method: This prospective randomized controlled trial enrolled 38 patients aged 60-80 years who underwent elective TURP with spinal anesthesia. The patients were randomly assigned to two treatment groups: Group D received IV 0.4 µg/kg dexmedetomidine, whereas Group C received IV normal saline after spinal anesthesia administration. The primary outcome was the time to 2-dermatome regression.
Results:The 2-dermatome regression time was longer in Group D than in Group C (104.44 ± 16.97 min vs. 80.63 ± 15.59 min, p < 0.05). The peak sensory block levels were significantly higher in Group D [T7 (T6-T8)] than in Group C [T10 (T7-T10)] (p = 0.017). The incidence of hypotension and bradycardia and postoperative pain at 0, 6, 12, and 24 h were not different between two groups.
Conclusion: Intravenous dexmedetomidine at a dosage of 0.4 µg/kg significantly prolongs the duration of spinal sensory blockade. Although postoperative analgesia was not different, it provided hemodynamic stability without increasing the side effects.
