CAJ | 학술논문

目的探讨以麻醉趋势指数( NTI)监测指导小剂量右美托咪定( DEX)用于高龄患者腰-硬联合麻醉期间镇静的可行性。方法选择下肢骨科手术患者50例ASAⅡ或Ⅲ级高龄患者并采用随机数字表法分为治疗组和对照组,各25例。腰-硬联合麻醉完成后,两组均经静脉持续输注DEX,负荷量0.4μg·kg-1,10 min输完,继以0.4μg·kg-1·h-1持续静脉输注。治疗组以NTI值75~85为目标调节输注速度,对照组则以镇静/警觉( OAA/S)评分3或4级为目标值调节输注速度。记录给予DEX即时( t0),给药后10 min( t1)、20 min( t2)、30 min( t3)、60 min( t4)及术毕时( t5)的平均动脉压( MAP)、心率( HR)、呼吸频率( RR)、脉搏血氧饱和度( SpO2)、NTI值及OAA/S评分。记录心动过缓、低血压的发生率。记录低氧合事件、呼吸抑制等不良事件的发生率。术后随访24 h记录患者DEX用药后至手术结束前对有关操作的遗忘程度。结果与t0比较,两组患者NTI、MAP t1~t5时均明显降低(P<0.01)；两组间比较,各时点MAP均差异无统计学意义(均P>0.05),治疗组NTI t2~t5时高于对照组(P<0.05)。与t0比较,两组患者OAA/S t1时均降低(P<0.05),t2~t5时明显降低(P<0.01),两组间比较,各时点OAA/S均差异无统计学意义(均P>0.05)。术后24 h随访,治疗组患者对手术操作完全遗忘为72.0%,对照组为76.0%,两组比较差异无统计学意义(P>0.05)。结论以NTI监测评价镇静深度,指导DEX用于高龄患者腰-硬联合麻醉期间镇静,安全可行,镇静深度适宜。
목적탐토이마취추세지수( NTI)감측지도소제량우미탁미정( DEX)용우고령환자요-경연합마취기간진정적가행성。방법선택하지골과수술환자50례ASAⅡ혹Ⅲ급고령환자병채용수궤수자표법분위치료조화대조조,각25례。요-경연합마취완성후,량조균경정맥지속수주DEX,부하량0.4μg·kg-1,10 min수완,계이0.4μg·kg-1·h-1지속정맥수주。치료조이NTI치75~85위목표조절수주속도,대조조칙이진정/경각( OAA/S)평분3혹4급위목표치조절수주속도。기록급여DEX즉시( t0),급약후10 min( t1)、20 min( t2)、30 min( t3)、60 min( t4)급술필시( t5)적평균동맥압( MAP)、심솔( HR)、호흡빈솔( RR)、맥박혈양포화도( SpO2)、NTI치급OAA/S평분。기록심동과완、저혈압적발생솔。기록저양합사건、호흡억제등불량사건적발생솔。술후수방24 h기록환자DEX용약후지수술결속전대유관조작적유망정도。결과여t0비교,량조환자NTI、MAP t1~t5시균명현강저(P<0.01)；량조간비교,각시점MAP균차이무통계학의의(균P>0.05),치료조NTI t2~t5시고우대조조(P<0.05)。여t0비교,량조환자OAA/S t1시균강저(P<0.05),t2~t5시명현강저(P<0.01),량조간비교,각시점OAA/S균차이무통계학의의(균P>0.05)。술후24 h수방,치료조환자대수술조작완전유망위72.0%,대조조위76.0%,량조비교차이무통계학의의(P>0.05)。결론이NTI감측평개진정심도,지도DEX용우고령환자요-경연합마취기간진정,안전가행,진정심도괄의。
Objective To investigate the feasibility of Narcotrend-guided application of small dose of dexmedetomidine ( DEX) for sedation during combined spinal-epidural anesthesia for elderly patients. Methods Fifty cases of ASA II or Ⅲelderly patients were randomly divided into treatment group and control group (25 patients of each group). After combined spinal-epidural anesthesia, both groups received continuous intravenous infusion of DEX, at 0. 4 μg·kg-1 in 10 min, and then the rate was lowered to 0. 4 μg·kg-1 per hour. For the treatment group, infusion rate was adjusted to reach a Narcotrend Index (NTI) of 75-85, and for the control group, infusion rate was adjusted to reach an OAA/S score of level 3-4. MAP, HR, RR, SpO2 , NTI and OAA/S score were recorded at the beginning of DEX treatment ( t0 ) , 10 min ( t1 ) , 20 min ( t2 ) , 30 min ( t3 ) , and 60 min ( t4 ) after the beginning of DEX treatment, and at the end of surgery ( t5 ) . The incidence rates of adverse events including bradycardia, hypotension, low oxygenation, and respiratory depression were also recorded. The patients were followed up until 24 h after surgery to record loss of memory about the surgical events. Results In comparison with t0 , NTI and MAP of both groups significantly decreased at t1-t5(P<0. 01). Comparison between the two groups showed no difference in MAP at each time point, and NTI of treatment group was higher than that of control group at t2-t5(P<0. 05). In comparison with t0, OAA/S of both groups significantly decreased at t1-t5(for t1, P<0. 05;for t2-t5, P<0. 01). Comparison between the two groups showed no difference in OAA/S at each time point (P>0. 05). Follow-up at 24 h after surgery observed total amnesia in 72. 0% of DEX group patients and in 76. 0% of the control group, without significant difference (P>0. 05). Conclusion Sedating elderly patients undergoing spinal-epidural anesthesia with DEX under the guidance of Narcotrend is safe and feasible, and the patients can be sedated properly.