CAJ | 학술논문

目的：评价右美托咪啶对全麻下肝癌高强度聚焦超声(high intensity focused ultrasound，HIFU)治疗患者苏醒期躁动的影响。方法第二炮兵总医院2009年12月-2013年1月择期肝癌HIFU治疗患者100例，年龄48~80岁，体重指数(BMI)18.2~26.5 kg/m2，美国麻醉医师协会(American Society of Anesthesiology，ASA)分级Ⅱ~Ⅲ级，将患者随机分为2组(n=50)：对照组(C组)及右美托咪啶组(D组)。D组麻醉诱导前经15 min静脉输注右美托咪啶负荷量0.7μg/kg，随后以0.2μg/(kg·h)的速率静脉输注至术毕，C组给予等容量0.9%氯化钠溶液。负荷量输注完毕后5 min 2组均静脉注射芬太尼2~3μg/kg、丙泊酚1.5~2 mg/kg和顺阿曲库铵0.2 mg/kg麻醉诱导。麻醉维持：吸入七氟醚(呼气末靶浓度1.5%~2%)，泵入瑞芬太尼0.01~0.02 mg/(kg·h)，泵入丙泊酚1.5~2 mg/(kg·h)，按需追加顺阿曲库铵0.05 mg/kg，维持脑电双频指数(bispectral index，BIS)40~60。记录丙泊酚、瑞芬太尼和七氟醚的用量、苏醒期躁动及术后24 h内谵妄发生情况。结果与C组比较，D组丙泊酚、瑞芬太尼和七氟醚的用量减少，苏醒期躁动发生率及术后24 h内谵妄的发生率降低(P＜0.05)，术中D组患者心率(heart rate，HR)降低(P＜0.05)。结论右美托咪啶可有效降低降低肝癌HIFU治疗患者苏醒期躁动的发生率，同时也降低了患者全麻用药量。
목적：평개우미탁미정대전마하간암고강도취초초성(high intensity focused ultrasound，HIFU)치료환자소성기조동적영향。방법제이포병총의원2009년12월-2013년1월택기간암HIFU치료환자100례，년령48~80세，체중지수(BMI)18.2~26.5 kg/m2，미국마취의사협회(American Society of Anesthesiology，ASA)분급Ⅱ~Ⅲ급，장환자수궤분위2조(n=50)：대조조(C조)급우미탁미정조(D조)。D조마취유도전경15 min정맥수주우미탁미정부하량0.7μg/kg，수후이0.2μg/(kg·h)적속솔정맥수주지술필，C조급여등용량0.9%록화납용액。부하량수주완필후5 min 2조균정맥주사분태니2~3μg/kg、병박분1.5~2 mg/kg화순아곡고안0.2 mg/kg마취유도。마취유지：흡입칠불미(호기말파농도1.5%~2%)，빙입서분태니0.01~0.02 mg/(kg·h)，빙입병박분1.5~2 mg/(kg·h)，안수추가순아곡고안0.05 mg/kg，유지뇌전쌍빈지수(bispectral index，BIS)40~60。기록병박분、서분태니화칠불미적용량、소성기조동급술후24 h내섬망발생정황。결과여C조비교，D조병박분、서분태니화칠불미적용량감소，소성기조동발생솔급술후24 h내섬망적발생솔강저(P＜0.05)，술중D조환자심솔(heart rate，HR)강저(P＜0.05)。결론우미탁미정가유효강저강저간암HIFU치료환자소성기조동적발생솔，동시야강저료환자전마용약량。
Objective To assess the effect of dexmedetomidine on agitation in awakening period of liver cancer patients after high intensity focused ultrasound (HIFU) therapy. Methods One hundred 48-80 years old ASAⅡorⅢliver cancer patients with their BMI being 18.2-26.5 kg/m2, admitted to General Hospital of Second Artillery Forces for HIFU therapy from December 2009 to January 2013, were randomly divided into control group and dexmedetomidine treatment group (50 in each group). Patients in dexmedetomidine treatment group were intravenously infused at the dose of 0.7μg/kg for 15 min before anesthesia followed by 0.2 μg/(kg · h) till the end of operation and those in control group were infused with the equal volume of 0.9%sodium chloride solution. Patients in both groups were anesthetized through iv injection of fentanyl (2-3μg/kg), propofol (1.5-2 mg/kg)and cisatracurium (0.2 mg/kg) 5 min after the loading dose was infused and maintained by inhaling sevoflurane (the end-tidal concentration was 1.5%-2%) and pumping remifentanil [0.01-0.02 mg/(kg · h)] and propofol [1.5-2 mg/(kg · h)] into trachea, and adding cisatracurium (0.05 mg/kg) when needed with the BIS maintained at 40-60. The volume of propofol, remifentanil and sevoflurane used, and the incidence of agitation in wakening period and delirium within 24 h after operation were recorded. Results The volume of propofol, remifentanil and sevoflurane used, the incidence of agitation in awakening period and delirium within 24 h after operation, and the heart rate were significantly lower in dexmedetomidine treatment group than in control group (P<0.05). Conclusion Dexmedetomidine can effectively reduce the incidence of agitation in awakening period of liver cancer patients after HIFU therapy and the volume of narcotics.