右美托咪定在经皮穿刺颈椎后路内镜下髓核摘除术中的应用
[摘要] 目的 觀察右美托咪定在经皮穿刺颈椎后路内镜下髓核摘除术中的应用效果。 方法 选择2016年3月～2017年11月我科收治的拟行经皮穿刺颈椎后路内镜下髓核摘除术颈椎病患者42例，随机分为右美托咪定组（D组）和安慰剂组（N组）。D组术中泵注右美托咪定，N组泵注生理盐水；两组术中均予利多卡因局麻。记录基础值（T1）、建立工作通道（T2）、打磨椎板、显露神经根（T3）、取髓核（T4）、术毕（T5）时的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）及警觉/镇静（OAA/S）评分，记录术中的不良反应、手术配合情况和患者满意度。 结果 D组T2、T3、T4时的HR、MAP和OAA/S评分，与N组比较差异有统计学意义（P<0.05）；D组T2、T3、T4时的OAA/S评分与T1、T5时比较，差异有统计学意义（P<0.05）。两组术中无不良反应发生。D组患者手术配合情况和患者满意度与N组比较，差异有统计学意义（P<0.05）。 结论 右美托咪定用于经皮穿刺颈椎后路内镜下髓核摘除术治疗神经根型颈椎病安全、有效。
[关键词] 右美托咪定；颈椎病；内镜；局部麻醉
[中图分类号] R614.3 [文献标识码] B [文章编号] 1673-9701（2018）08-0108-04
Application of dexmedetomidine in endoscopic discectomy with percutaneous needle posterior cervical spine
SHEN Bangli1 GONG Gonghao1 XU Feng1 HUANG Xixi1 WANG Peifang1 LIU Huacheng2 HUANG Xiaofang3
1.Department of Pain，the Second Affiliated Hospital of Wenzhou Medical University，Wenzhou 325027，China；2.Department of Anesthesiology，the Second Affiliated Hospital of Wenzhou Medical University，Wenzhou 325027，China；3.Department of Catheter Interventional Room，the Second Affiliated Hospital of Wenzhou Medical University，Wenzhou 325027，China
[Abstract] Objective To observe the effect of dexmedetomidine in endoscopic discectomy by percutaneous pinning of posterior cervical spine. Methods From March 2016 to November 2017， 42 patients with cervical spondylotic myelopathy who underwent endoscopic percutaneous cervical discectomy who underwent percutaneous puncture in our department were randomly divided into two groups： Dexmedetomidine group（D group）and placebo group（N group）. Group D was intramuscularly injected with dexmedetomidine， and group N was infused with normal saline. Both groups were given local anesthesia with lidocaine. The basic values （T1）， working channel（T2）， laminectomy， nerve root（T3）， nucleus pulposus（T4）， heart rate（HR） and mean arterial pressure（MAP）SpO2， and OAA/S scores were recorded. The adverse reactions， surgical cooperation and patient satisfaction were recorded. Results The scores of HR， MAP and OAA/S at T2， T3 and T4 in group D were significantly different from those in group N（P<0.05）. The scores of OAA/S at T2， T3 and T4 in group D were significantly higher than those in group T1 ， T5， the difference was statistically significant（P<0.05）. No adverse reactions occurred during operation in both groups. Compared with N group， the difference of operation cooperation and patient satisfaction in group D was statistically significant（P<0.05）. Conclusion Dexmedetomidine is safe and effective in treating cervical spondylotic radiculopathy due to endoscopic cervical discectomy with percutaneous puncture.