浙江临床医学
浙江臨床醫學
절강림상의학
ZHEJIANG CLINICAL MEDICAL JOURNAL
2014年
3期
360-361,362
,共3页
右美托咪定%咪达唑仑%蛛网膜下腔阻滞%镇静%牵拉反应
右美託咪定%咪達唑崙%蛛網膜下腔阻滯%鎮靜%牽拉反應
우미탁미정%미체서륜%주망막하강조체%진정%견랍반응
Dexmedetomidine%Midazolam%Subarachnoid block%Sedation%Drag reaction
目的：比较氯普鲁卡因蛛网膜下腔阻滞下行输尿管镜手术时右美托咪定和咪达唑仑的镇静效果及不良反应。方法80例择期行输尿管镜下钬激光碎石术或支架置入术的患者随机分成右美托咪定组（D组）和咪达唑仑组（M组），以2.5%氯普鲁卡因1.6ml行蛛网膜下腔阻滞神经阻滞，麻醉效果满意后开始镇静，分别予右美托咪定1.0g/kg及咪达唑仑0.1mg/kg，观察两组麻醉前（T0）、开始镇静时（T1）、输注镇静药后5min（T2）、输尿管镜置入后5min（T3）、手术结束时（T4）生命体征变化。记录两组镇静起效时间、效果和持续时间，并观察两组不良反应发生情况。结果 T2、T3时，2组患者血压、心率及M组脉搏血氧饱和度（SpO2）均较T1时降低（P<0.05），D组SpO2无显著变化。D组镇静起效时间短于M组（P<0.05），镇静深度D组集中于Ⅲ级，而M组多分布于Ⅱ级及Ⅵ级，D组满意率高于M组且镇静持续时间长于M组（P<0.05）。D组不良反应主要为术中心动过缓和术后头晕，而M组多见呼吸抑制和术后头晕，不良发生率D组（25%）低于M组（48%），（P<0.05）。结论右美托咪定较咪达唑仑更适用于腰麻下输尿管镜手术中镇静。
目的：比較氯普魯卡因蛛網膜下腔阻滯下行輸尿管鏡手術時右美託咪定和咪達唑崙的鎮靜效果及不良反應。方法80例擇期行輸尿管鏡下鈥激光碎石術或支架置入術的患者隨機分成右美託咪定組（D組）和咪達唑崙組（M組），以2.5%氯普魯卡因1.6ml行蛛網膜下腔阻滯神經阻滯，痳醉效果滿意後開始鎮靜，分彆予右美託咪定1.0g/kg及咪達唑崙0.1mg/kg，觀察兩組痳醉前（T0）、開始鎮靜時（T1）、輸註鎮靜藥後5min（T2）、輸尿管鏡置入後5min（T3）、手術結束時（T4）生命體徵變化。記錄兩組鎮靜起效時間、效果和持續時間，併觀察兩組不良反應髮生情況。結果 T2、T3時，2組患者血壓、心率及M組脈搏血氧飽和度（SpO2）均較T1時降低（P<0.05），D組SpO2無顯著變化。D組鎮靜起效時間短于M組（P<0.05），鎮靜深度D組集中于Ⅲ級，而M組多分佈于Ⅱ級及Ⅵ級，D組滿意率高于M組且鎮靜持續時間長于M組（P<0.05）。D組不良反應主要為術中心動過緩和術後頭暈，而M組多見呼吸抑製和術後頭暈，不良髮生率D組（25%）低于M組（48%），（P<0.05）。結論右美託咪定較咪達唑崙更適用于腰痳下輸尿管鏡手術中鎮靜。
목적：비교록보로잡인주망막하강조체하행수뇨관경수술시우미탁미정화미체서륜적진정효과급불량반응。방법80례택기행수뇨관경하화격광쇄석술혹지가치입술적환자수궤분성우미탁미정조（D조）화미체서륜조（M조），이2.5%록보로잡인1.6ml행주망막하강조체신경조체，마취효과만의후개시진정，분별여우미탁미정1.0g/kg급미체서륜0.1mg/kg，관찰량조마취전（T0）、개시진정시（T1）、수주진정약후5min（T2）、수뇨관경치입후5min（T3）、수술결속시（T4）생명체정변화。기록량조진정기효시간、효과화지속시간，병관찰량조불량반응발생정황。결과 T2、T3시，2조환자혈압、심솔급M조맥박혈양포화도（SpO2）균교T1시강저（P<0.05），D조SpO2무현저변화。D조진정기효시간단우M조（P<0.05），진정심도D조집중우Ⅲ급，이M조다분포우Ⅱ급급Ⅵ급，D조만의솔고우M조차진정지속시간장우M조（P<0.05）。D조불량반응주요위술중심동과완화술후두훈，이M조다견호흡억제화술후두훈，불량발생솔D조（25%）저우M조（48%），（P<0.05）。결론우미탁미정교미체서륜경괄용우요마하수뇨관경수술중진정。
Objective AIM To compare the sedative effect and adverse reaction of dexmedetomidine and midazolam in ureteroscope operation under short lumbar anesthesia with chloropro-caine. METHODS Eighty patients undergoing ureteroscope surgery for lithotripsy or bracket insertion were randomly divided into 2 groups with 40 for each. The patients in both groups were injected with 2.5%chloroprocaine 1.6mL in subarachnoid . After the satisfactory anaesthesia effect attained,the patients in dexmedetomidine group(group D) and midazolam group (group M) received dexmedetomidine 1.0g/kg(group D) and midazolam 0.1mg/kg respectively. The patients’vital signs were recorded before anaesthesia (T0),at sedation beginning (T1), 5min after injection of sedatives(T2),5min after ureteroscope insertion (T3) and complete the operation (T4). The onset time of sedation,duration of effects and the occurrence of adverse reactions were observed. Results The patients’ blood pressure,heart rate in both groups and pulse oxygen saturation(SpO2)in the group M at T2,T3 were decreased compared with those at T0(P<0.05). While the SpO2 in the group D showed no obvious changes. The onset time of sedation in the group D was shorter compared with that in the group M(P<0.05). The sedation deepness in the group D centralized at gradeⅢin the group D,while distributed by gradeⅡorⅥin the group M. The satisfaction rate in the group D was higher than that in the group M(P<0.05). The continued sedation time in the group D was longer than that in the group M(P<0.05). Intraoperative bradycardia and post-surgery depression was major adverse reactions in the group D. Dizziness and postoperative respiratory depression were mainly seen in the group M. The adverse reaction rate of group D(25%) was lower than that in the group M (48%,P<0.05). Conclusion Sedation with dexmedetomidine in the ureteroscope operation with lumbar anesthesia is more suitable than midazolam.
