Objective To evaluate the effects of dexmedetomidine on lumbar epidural anaesthesia with 0. 75％ levobupivacaine in patients with lower abdominal gynecologic operation. Methods Sixty patients ( ASA Ⅰ ～ Ⅱ ), aged 43 ～ 65 year, for selected lower abdominal gynecologic operation were randomly divided into two groups: Group L ( levobupivacaine ) as the control group and Group LD ( levobupivacaine & dexmedetomidine ) as the test group. Epidural block was performed at the L2-3 interspace. Epidural injection of 15 mL 0. 75％ levobupivacaine and 2 mL normal saline was performed in Group L, with 15 mL 0. 75％ levobupivacaine and 2 mL dexmedetomidine of 1. 0 μg/kg in Group LD.Age, height, weight, ASA grade, operation length, blood loss and fluid volume were recorded. Sensory and motor blocks were also assessed. MAP, HR, SpO2 and BIS were recorded at baseline, and 5 , 10 , 20 , 30 and 60 min after anesthesia.Meanwhile, adverse events, including hypotension, tachycardia, nausea, vomiting and shivering, were also recorded.Furthermore, intraoperation pain, abdominal muscles relaxing and traction reflex were applied for assessment of anesthesia. Results There was no significant difference in general conditions of patients in two groups ( P ＞ 0. 05 ). Neither was the latency of sensory block, maximal sensory block time or latency of motor block ( P ＞ 0. 05 ). In Group LD , significantly longer sensory block and motor block were observed than those in Group L ( P ＜ 0. 01 ) , with significantly shorter maximal motor block time ( P ＜ 0. 05 ). Moreover, significantly higher maximal motor block scores 20 and 30 min after epidural injection was revealed in Group LD than those in Group L ( P ＜ 0. 05 ). Significant reduction of BIS was revealed in the both groups 20 min after epidural injection when comparing with baseline ( P ＜ 0. 05 ) , while significantly lower BIS was revealed in Group LD than that in Group L ( P ＜ 0. 01 ). Significant lower MAP were revealed 10 and 20 min after anesthesia in Group LD and L when comparing with those at baseline, so was the HR in Group LD 10 min after anesthesia ( P ＜0. 05 ) . Comparing with those in Group L , significantly lower MAP and HR were observed in Group LD 10 min after anesthesia ( P ＜0. 05 ). Furthermore, significantly lower shivering incidence was recorded in group LD than that in group L ( P ＜0. 01 ). Conclusion Additional dexmedetomidine in epidural anesthesia with levobupivacaine improves anesthesia via prolonging sensory and motor block, and enhancing motor block and pain relief.%目的 观察右旋美托咪啶对左旋布比卡因妇科手术腰段硬膜外麻醉的影响.方法 妇科择期子宫肌瘤手术(ASAⅠ～Ⅱ级)60例,随机均分为左旋布比卡因硬膜外麻醉组(L组)和左旋布比卡因+右旋美托咪啶硬膜外麻醉组(LD组).L组常规消毒穿刺后硬膜外注入0.75%左旋布比卡因15 mL+生理盐水2 mL,LD组注入0.75%左旋布比卡因15 mL+ 右旋美托咪啶1.0 μg/kg (2 mL).记录年龄、身高、体重、ASA级、手术时间、失血量和输液量等一般情况;评估感觉阻滞和运动阻滞效果;监测和记录硬膜外给药前(0)、硬膜外给药后5、10、20、30和60 min MAP、HR、SpO2和BIS值及低血压、心动过缓、恶心、呕吐和寒战等不良反应;从术中疼痛程度、腹肌松弛度和牵拉反应3方面评估麻醉效果.结果 两组感觉阻滞起效时间、最高感觉阻滞时间、运动阻滞起效时间组间比较差异无统计学意义(P>0.05).LD组感觉阻滞维持时间和运动阻滞恢复时间大于L组(P＜0.01),最大运动阻滞时间短于L组(P＜0.05),20和30 min最大运动阻滞评分高于L组(P＜0.05).与L组比较,LD组疼痛程度和牵拉反应程度降低(P＜0.01).与基础值比较,L组和LD组BIS值于20 min后降低(P＜0.05,P<0.01),LD组BIS值于20 min后低于L组(P＜0.01).与基础值比较,L组和LD组MAP分别于硬膜外注药后20和10 min时降低(P＜0.05,P<0.01),LD组HR于硬膜外注药10 min后降低(P＜0.05);与L组比较,LD组MAP和HR于硬膜外注药10 min后降低(P＜0.05).LD组寒战发生例次低于L组(P＜0.01).结论 左旋布比卡因混合右旋美托咪啶1.0 μg/kg感觉阻滞和运动阻滞维持时间延长,运动阻滞和镇痛作用增强,麻醉效果更加完善.
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