CAJ | 학술논문

目的：：观察不同剂量右美托咪啶在硬膜外麻醉经腹子宫全切术中的镇静效果和安全性。方法：硬膜外麻醉经腹子宫全切术择期患者120例随机分为4组,即不同剂量右美托咪啶镇静组( D1组,D2组,D3组)和咪达唑仑镇静组( M组)。 D1组、D2组、D3组在手术前10 min静脉泵注右美托咪啶0.5μg·kg-1,随之分别以0.4,0.6,0.8μg·( kg·h)-1维持输注；M组患者在手术前10 min静脉泵注咪达唑仑0.06 mg·kg-1,随之以0.04 mg·(kg·h)-1维持输注。比较各组患者入室时(T0)、确定硬膜外麻醉阻滞效果满意时(T1)、镇静药物泵注后10 min(T2)、20 min(T3)、40 min(T4)、手术结束时(T5)的平均动脉压( MAP)、心率( HR)、呼吸频率( RR)和血氧饱和度( SpO2),以及镇静药物使用时间和手术时间。评估各时点镇静程度,及术后患者手术期间遗忘程度、药品不良反应和麻醉服务满意度。结果： T3时点后,D3组HR显著低于其余3组(P<0.05)；T2时点后,4组HR均明显低于T0时(P<0.05和P<0.01)。 M组T3、T4时点RR显著低于其余3组(P<0.05)。与T0时比较,T2时点后,各组患者均取得显著镇静效果(P<0.05和P<0.01)；D3组T3、T4时镇静评分显著优于D1组和M组(P<0.05)。4组患者均未出现明显药品不良反应。结论：硬膜外麻醉经腹子宫全切术应用右美托咪啶维持镇静无类似输注咪达唑仑后发生呼吸抑制的风险,但剂量宜低于0.8μg·(kg·h)-1。
목적：：관찰불동제량우미탁미정재경막외마취경복자궁전절술중적진정효과화안전성。방법：경막외마취경복자궁전절술택기환자120례수궤분위4조,즉불동제량우미탁미정진정조( D1조,D2조,D3조)화미체서륜진정조( M조)。 D1조、D2조、D3조재수술전10 min정맥빙주우미탁미정0.5μg·kg-1,수지분별이0.4,0.6,0.8μg·( kg·h)-1유지수주；M조환자재수술전10 min정맥빙주미체서륜0.06 mg·kg-1,수지이0.04 mg·(kg·h)-1유지수주。비교각조환자입실시(T0)、학정경막외마취조체효과만의시(T1)、진정약물빙주후10 min(T2)、20 min(T3)、40 min(T4)、수술결속시(T5)적평균동맥압( MAP)、심솔( HR)、호흡빈솔( RR)화혈양포화도( SpO2),이급진정약물사용시간화수술시간。평고각시점진정정도,급술후환자수술기간유망정도、약품불량반응화마취복무만의도。결과： T3시점후,D3조HR현저저우기여3조(P<0.05)；T2시점후,4조HR균명현저우T0시(P<0.05화P<0.01)。 M조T3、T4시점RR현저저우기여3조(P<0.05)。여T0시비교,T2시점후,각조환자균취득현저진정효과(P<0.05화P<0.01)；D3조T3、T4시진정평분현저우우D1조화M조(P<0.05)。4조환자균미출현명현약품불량반응。결론：경막외마취경복자궁전절술응용우미탁미정유지진정무유사수주미체서륜후발생호흡억제적풍험,단제량의저우0.8μg·(kg·h)-1。
Objective:To compare the sedative effect and safety of different doses of dexmedetomidine in the patients undergoing total abdominal hyserectomy. Methods:A total of 120 patients undergoing total abdominal hysterectomy were randomly divided into four groups, different doses of dexmedetomidine groups(D1 group, D2 group and D3 group)and midazolam group(M group) with 30 pa-tients in each. Dexmedetomidine groups received intravenous pump infusion of dexmedetomidine (0. 5 μg·kg-1 ) 10 minutes before the operation, and then the different dexmedetomidine groups were received continuous infusion of dexmedetomine of different doses:D1 group of 0. 4μg·(kg·h) -1, D2 group with 0. 6μg·(kg·h) -1 and D3 group with 0. 8μg·(kg·h) -1;M group received in-travenous pump infusion of midazolam (0. 06 mg·kg-1) 10 minutes before the operation, and then with 0. 04 mg·(kg·h) -1 con-tinuous infusion. The mean arterial pressure( MAP) , heart rate( HR) , respiratory rate( RR) , oxyhemoglobin saturation( SpO2 ) were recorded at the following time points:the moment of entering the operating room(T0), the block effect of epidural anesthesia was satis-fied (T1),10 min(T2),20 min(T3)and 40 min(T4)after the drug infusion, and the end of the operation(T5), and the duration of the medicine use and the whole operation were recorded as well. The sedation degrees were evaluated with Ramsay scale, and the am-nesic scores, adverse drug reactions and patient satisfaction were recorded after the operation. Results:Compared with that of the other groups, HR of D3 group was obviously lower after T3 (P<0. 05);and after T2, HR was significantly lower than that at T0 (P<0. 05 or P<0. 01). Compared with the other groups, RR of M group was obviously lower at T3 and T4 (P<0. 05). Compared with those at T0 , the sedative effects of all the groups were much remarkable(P<0. 05 or P<0. 01);and the Ramsay score of D3 group at T3 and T4 was higher than that in D1 group or M group(P<0. 05). There were no obvious adverse reactions in the four groups. Conclusion:The use of dexmedetomidine in the patients undergoing total abdominal hyserectomy might not lead to the risk of respiratory depression as the use of midazolam, while the dose of dexmedetomidine should be less than 0. 8 μg·(kg·h) -1.