目的

观察不同剂量右美托咪定滴鼻在老年经皮椎体成形术（PVP）术中的效果。

方法

选择2023 年6 月至12 月期间在成都市郫都区中医医院择期行PVP 术的老年患者100 例，其中男性38例，女性62 例；年龄60～79 岁，平均（69.08±4.86）岁。美国麻醉医师协会（ASA）分级Ⅰ～Ⅲ级。采用前瞻性随机对照研究将患者分成4组（每组25例）：右美托咪定0.8 μg/kg组（D1组）、1.0 μg/kg组（D2组）、1.2 μg/kg组（D3组）和等渗盐水对照组（N组）。比较各组患者入手术室即刻（T1）、滴鼻后30 min（T2）、穿刺套管到达椎体即刻（T3）、推注骨水泥（T4）、术毕恢复体位后5 min（T5）的Ramsay 镇静评分、视觉模拟评分（VAS）、平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO₂）。记录术中不良反应等情况。

结果

（1）滴鼻后D3 组的各时间点的镇静评分均高于其他组（P＜0.05）。（2）T3、T4 时，D3 组的VAS 评分低于其他组（P＜0.05）。（3）D3 组在T3 时、T4 时MAP、HR 与T2 时相比差异无统计学意义（P＞0.05）。（4）各组术后血糖相较于术前均有升高（P＜0.05），D3 组血糖升高幅度低于其他各组（P＜0.05）。（5）D3组利多卡因用量和手术时间低于其余组（P＜0.05），D3 组满意度评分高于其他各组（P＜0.05）。（6）N 组躁动和术中高血压发生率高于其他组（P＜0.05）。（7）各组不良反应发生情况差异无统计学意义（P＞0.05）。

结论

对于行PVP 治疗的老年患者，术前经鼻滴入1.2 μg/kg 右美托咪定可有效镇静镇痛，同时患者更加安全、舒适、满意。

Objective

To observe the effect of different doses of dexmedetomidine nasal drops in the elderly percutaneous vertebroplasty （PVP）.

Methods

A total of 100 elderly patients who underwent elective Percutaneous Vertebroplasty （PVP） at the Traditional Chinese Medicine Hospital of Pi District，Chengdu City from June to December 2023， including 38 males and 62 females. Their ages ranged from 60 to 79 years old， with an average age of （69.08±4.86） years. Patients were divided into 4 groups（n=25） by random number table method： dexmedetomidine 0.8 μg/kg group （D1 group）， 1.0 μg/kg group （D2 group）， 1.2 μg/kg group （D3 group） and normal saline control group （N group）. Ramsay calm score， visual analog scale （VAS）， mean arterial pressure （MAP）， heart rate （HR） and pulse oxygen saturation （SpO₂） were compared immediately after entering the operating room （T1）， 30 min after nasal drops （T2）， immediately after cannula reached vertebra （T3）， bone cement injection （T4）， and 5 min after resuming position （T5）between the groups. Intraoperative adverse reactions were recorded.

Results

The sedation score at each time point of D3 group after nasal drip was higher than that of other groups （P＜0.05）.At T3 and T4，the pain score of D3 group was lower than that of other groups （P＜0.05）. There was no significant difference in MAP and HR of D3 group at T3 and T4 compared with T2 （P＞0.05）.Postoperative blood glucose in all groups was higher than that before surgery （P＜0.05）， and the increase of blood glucose in D3 group was lower than that in other groups （P＜0.05）. The amount of lidocaine and operation time in D3 group were lower than those in other groups （P＜0.05）， and the satisfaction score in D3 group was higher than that in other groups （P＜0.05）.The incidence of agitation and intraoperative hypertension in group N was higher than that in other groups（P＜0.05）.However，there was no statistical difference in the occurrence of adverse reactions among all groups（P＞0.05）.

Conclusion

For elderly patients undergoing PVP treatment， 1.2 μg/kg of dexmedetomidine can be effectively sedated and analgesic before operation，and patients are safer，more comfortable and satisfied.