CAJ | 학술논문

目的比较和评估右美托咪啶(dexmedetomidine,DEX)和咪达唑仑用于骨科下肢手术中镇静的效果和安全性.方法骨科下肢手术患者52例,均接受腰硬联合麻醉,按镇静方法完全随机分为两组:D组27例,以DEX0.5μg·kg-1·h-1静脉恒速输注(负荷量0.5 μg/kg);M组25例,以咪达唑仑50 μg·kg-1·-1静脉恒速输注(负荷量30 μg/kg).两组均将脑电双频指数(bispectral index,BIS)控制在≤85,并以此为依据相应选择加深镇静或停止输注减浅镇静,同时记录剂量的调整.术中记录呼吸频率(respiration rate,RR)、心率(HR)、脉搏血氧饱和度(pulse oxygen satuation,SpO2)、平均动脉压(MAP),并在术毕停药前评估记录患者的Ramsay镇静评分(RSS评分).结果 D组的HR(72±7)次,分在用药30 min后相比M组(83±8)次,分显著减慢(P<0.05),RR、MAP在各时点差异无统计学意义(P>0.05).两组的停药前RSS评分差异无统计学意义(P>0.05).D组有6例、M组有7例需要进行剂量调整.另外,M组有5例因舌后坠致SpO2下降需托下颌处理,D组无类似情况.结论 DEX用于骨科下肢手术镇静可引起HR减慢但对血压无明显影响;在相同的镇静程度下,DEX比咪达唑仑更有利丁维持呼吸道通畅,可能更适用于该类手术的镇静.
목적 비교화평고우미탁미정(dexmedetomidine,DEX)화미체서륜용우골과하지수술중진정적효과화안전성.방법 골과하지수술환자52례,균접수요경연합마취,안진정방법 완전수궤분위량조:D조27례,이DEX0.5μg·kg-1·h-1정맥항속수주(부하량0.5 μg/kg);M조25례,이미체서륜50 μg·kg-1·-1정맥항속수주(부하량30 μg/kg).량조균장뇌전쌍빈지수(bispectral index,BIS)공제재≤85,병이차위의거상응선택가심진정혹정지수주감천진정,동시기록제량적조정.술중기록호흡빈솔(respiration rate,RR)、심솔(HR)、맥박혈양포화도(pulse oxygen satuation,SpO2)、평균동맥압(MAP),병재술필정약전평고기록환자적Ramsay진정평분(RSS평분).결과 D조적HR(72±7)차,분재용약30 min후상비M조(83±8)차,분현저감만(P<0.05),RR、MAP재각시점차이무통계학의의(P>0.05).량조적정약전RSS평분차이무통계학의의(P>0.05).D조유6례、M조유7례수요진행제량조정.령외,M조유5례인설후추치SpO2하강수탁하합처리,D조무유사정황.결론 DEX용우골과하지수술진정가인기HR감만단대혈압무명현영향;재상동적진정정도하,DEX비미체서륜경유리정유지호흡도통창,가능경괄용우해류수술적진정.
Objective To compare and evaluate the effect and safety of dexmedetomidine(DEX) and midazolam sedation in lower limbs orthopaedic surgery. Methods Fifty-two patients undergoing lower limbs surgery were randomly assigned to group D (n=27,DEX, 0.5 μg·kg-1·h-1, loading dose 0.5 μg/kg) and group M(n=25, midazolam, 50 μg·kg-1·h-1, loading dose 30 μg/kg). An infusion was administered after mounting a bispectral index (BIS) monitor under combined spinal-epidural anesthesia. The target BIS level was≤85. An additional bolus dose of the study drug or cessation of the infusion was adjusted according to the BIS level, and the change should be recorded. Respiratory rates (RR), heart rate (HR), pulse oxygen saturation (SpO2), mean arterial blood pressure (MAP) were continually monitored. Sedation should be evaluated according to the Ramsay sedation scale(RSS) before the drug withdrawal. Results HR was lower in group D (72±7) bpm than that in group M (83±8) bpm (P<0.05) 30 min after infusion. There was no significant difference in the RR, MAP and RSS score between two groups. Dose adjustments were required in six and seven patients Groups D and M, respectively. Five patients needed to raise the mandible due to SpO2 decline by glossocoma in Group M, but none in Group D. Conclusion DEX infusion mildly decreased heart rate in the later periods of lower limbs surgery, with no significant influences on the MAP. Compared with midazolam, DEX might show more advantages in maintaining the unobstructed of the respiratory tract, and be more suitable for sedation in lower limbs surgery.