CAJ | 학술논문

目的：探讨右旋美托嘧啶对术中镇静药量和术后谵妄的影响。方法：选取2012年3月-2013年8月在本院于全麻下行腹腔镜胆总管切开取石术患者60例为研究对象，随机数字表法分成A、B两组。A组30例患者采用静注右旋美托嘧啶（DEX）方案，于术前10 min按照0.7μg/kg剂量肘前静脉注射DEX，术中以0.4μg/（kg·h）的速度持续给药；B组30例患者给予静注生理盐水方案，剂量、给药方式及速度均与A组一致。对比两组患者术中丙泊酚用量，分析其术后镇静警醒评分（OAA/S评分）、舒适度评分、VAS评分及谵妄分级量差异。结果：A组患者术中丙泊酚用量为（480.4±23.4）mL，明显低于B组患者的（699.9±38.4）mL，组间对比差异具有统计学意义（P<0.05）；B组患者插管时血浆中丙泊酚浓度为（3.69±2.25）μg/mL，明显高于A组患者的（2.43±1.59）μg/mL，组间对比差异有统计学意义（P<0.05）；B组患者OAA/S评分为（1.5±0.3）分，明显低于A组的（1.9±0.2）分，组间对比差异具有统计学意义（P<0.05）；A组患者舒适度评分与VAS评分均优于B组患者，但组间对比差异无统计学意义（P>0.05）。A组患者术后谵妄分级量评分为（13.52±4.59）分，明显低于B组患者的（16.03±5.64）分，组间对比差异有统计学意义（P<0.05）。结论：全麻术中静注右旋美托嘧啶，能有效降低术中镇静药物用量、控制患者血液中丙泊酚浓度，对减少术后谵妄发生率具有一定的积极意义，值得临床推广使用。
목적：탐토우선미탁밀정대술중진정약량화술후섬망적영향。방법：선취2012년3월-2013년8월재본원우전마하행복강경담총관절개취석술환자60례위연구대상，수궤수자표법분성A、B량조。A조30례환자채용정주우선미탁밀정（DEX）방안，우술전10 min안조0.7μg/kg제량주전정맥주사DEX，술중이0.4μg/（kg·h）적속도지속급약；B조30례환자급여정주생리염수방안，제량、급약방식급속도균여A조일치。대비량조환자술중병박분용량，분석기술후진정경성평분（OAA/S평분）、서괄도평분、VAS평분급섬망분급량차이。결과：A조환자술중병박분용량위（480.4±23.4）mL，명현저우B조환자적（699.9±38.4）mL，조간대비차이구유통계학의의（P<0.05）；B조환자삽관시혈장중병박분농도위（3.69±2.25）μg/mL，명현고우A조환자적（2.43±1.59）μg/mL，조간대비차이유통계학의의（P<0.05）；B조환자OAA/S평분위（1.5±0.3）분，명현저우A조적（1.9±0.2）분，조간대비차이구유통계학의의（P<0.05）；A조환자서괄도평분여VAS평분균우우B조환자，단조간대비차이무통계학의의（P>0.05）。A조환자술후섬망분급량평분위（13.52±4.59）분，명현저우B조환자적（16.03±5.64）분，조간대비차이유통계학의의（P<0.05）。결론：전마술중정주우선미탁밀정，능유효강저술중진정약물용량、공제환자혈액중병박분농도，대감소술후섬망발생솔구유일정적적겁의의，치득림상추엄사용。
Objective:To investigate the effects of dexmedetomidine on intraoperative sedation dose and postoperative delirium.Method: 60 patients in general anesthesia laparoscopic common bile duct lithotomy incision were selected from March 2012 to August 2013 in our hospital as the research object, and were randomly divided into A, B two groups. 30 patients in A group were treated by intravenous infusion of dexmedetomidine (DEX) scheme, 10 minutes in accordance with the 0.7 μg/kg dose antecubital vein injection of DEX before operation, 0.4 μg/(kg·h) in the operation speed per hour continuous infusion; 30 cases in B group were treated with intravenous injection of physiological saline solution, dosage, administration method and speed with A consistent set. Comparison of the two groups’ patients with propofol dosage, analyzed the postoperative sedation score (OAA/S score), watch the comfort score, VAS score and the delirium rating differences.Result: Propofol in A group was (480.4±23.4)mL, significantly lower than that in B group (699.9±38.4)mL, there were statistical significance between the two groups (P<0.05). Patients in B group were intubated when propofol concentration in plasma was (3.69±2.25)μg/mL, significantly higher than that in A group (2.43±1.59)μg/mL, differences between the two groups were compared (P<0.05). OAA/S score in B group patients was (1.5±0.3), which was lower than A group (1.9±0.2), the comparison between the two groups was statistical significance (P<0.05); comfort scores and VAS scores in A group were better than those in B group, but no significant difference between the two groups, was not statistically significant (P>0.05). Score of patients in A group was (13.52±4.59) after delirium rating, which was significantly lower than B group (16.03±5.64), differences were significant (P<0.05).Conclusion: Intravenous dexmedetomidine during general anesthesia, can effectively reduce the dosage of sedative drugs during the operation, control the propofol concentration in blood of the patients, there has certain positive significance to reduce the incidence of postoperative delirium, so it is worthy of clinical use.