CAJ | 학술논문

目的：比较右美托咪定与芬太尼分别联合丙泊酚用于超声引导下经皮微波消融疗法（ percutaueous microwave co-agulation therapy，PMCT）治疗肝癌的麻醉效果。方法 ASAⅠ～Ⅱ级预行PMCT治疗肝癌患者40例，随机分成芬太尼组（ F组，n＝20）和右美托咪定组（D组，n＝20）。开放静脉后，F组缓慢静脉注射芬太尼1μg /kg，D组静脉微量泵注射右美托咪定0．5μg /kg（注射时间为10 min），继以0．5μg/（kg· h）静脉维持至PMCT结束前5 min左右。局部麻醉下超声引导定位后，F组和D组分别以丙泊酚1～2 mg/kg和0．5 mg/kg（注药速度4 ml/10 s）静脉注射诱导，分别以丙泊酚6～8 mg/（kg· h）和3～4 mg/（kg· h）静脉输注维持至PMCT结束；术中出现呻吟不适或身体扭动者追加丙泊酚20～30 mg/次。观察两组患者丙泊酚用量、苏醒时间、术中BP、HR和SpO2的变化，以及围术期并发症发生情况。治疗结束后30 min进行VRS疼痛评分并调查患者对麻醉的满意度。结果丙泊酚用量D组显著低于F组（P＜0．01），苏醒时间D组明显长于F组（P＜0．01）。 F组SBP、DBP和HR在PMCT治疗前后波动大于D组（P＜0．05）。 F组心动过缓、低血压、呼吸暂停和注射痛发生率分别为30％、20％、30％及90％，D组患者未有以上情况发生，两组比较差异有统计学意义（注射痛P＜0．01，余P＜0．05）。治疗结束后30 min ，VRS疼痛评分F组明显高于D组（P＜0．01），患者满意率D组明显高于F组（P＜0．05）。结论两种麻醉方法均能满足PMCT治疗肝癌的需要，但右美托咪定除苏醒时间延长外，能显著减少丙泊酚用量，且不良反应少，对呼吸循环功能影响更小，患者满意率更高。
목적：비교우미탁미정여분태니분별연합병박분용우초성인도하경피미파소융요법（ percutaueous microwave co-agulation therapy，PMCT）치료간암적마취효과。방법 ASAⅠ～Ⅱ급예행PMCT치료간암환자40례，수궤분성분태니조（ F조，n＝20）화우미탁미정조（D조，n＝20）。개방정맥후，F조완만정맥주사분태니1μg /kg，D조정맥미량빙주사우미탁미정0．5μg /kg（주사시간위10 min），계이0．5μg/（kg· h）정맥유지지PMCT결속전5 min좌우。국부마취하초성인도정위후，F조화D조분별이병박분1～2 mg/kg화0．5 mg/kg（주약속도4 ml/10 s）정맥주사유도，분별이병박분6～8 mg/（kg· h）화3～4 mg/（kg· h）정맥수주유지지PMCT결속；술중출현신음불괄혹신체뉴동자추가병박분20～30 mg/차。관찰량조환자병박분용량、소성시간、술중BP、HR화SpO2적변화，이급위술기병발증발생정황。치료결속후30 min진행VRS동통평분병조사환자대마취적만의도。결과병박분용량D조현저저우F조（P＜0．01），소성시간D조명현장우F조（P＜0．01）。 F조SBP、DBP화HR재PMCT치료전후파동대우D조（P＜0．05）。 F조심동과완、저혈압、호흡잠정화주사통발생솔분별위30％、20％、30％급90％，D조환자미유이상정황발생，량조비교차이유통계학의의（주사통P＜0．01，여P＜0．05）。치료결속후30 min ，VRS동통평분F조명현고우D조（P＜0．01），환자만의솔D조명현고우F조（P＜0．05）。결론량충마취방법균능만족PMCT치료간암적수요，단우미탁미정제소성시간연장외，능현저감소병박분용량，차불량반응소，대호흡순배공능영향경소，환자만의솔경고。
Objective To compare the anesthetic effect of propofol combined with dexmedetomidine or fentanyl in ultrasonical-ly guided percutaneous microwave coagulation therapy ( PMCT) for hepatocellular carcinoma ( HCC) .Methods Forty HCC patients ( ASAⅠ-Ⅱ) were allocated randomly to two groups with 20 cases each.The patients in group F received intravenous anesthesia with fentanyl combined with propofol, and the patients in group D received intravenous anesthesia with dexmedetomidine combined with propofol during PMCT for HCC.The consumption of propofol, recovery time, BP, HR, SpO2 and complications were assessed.VRS and patient’ s satisfactions were assessed at 30 minutes after PMCT.Results The consumption of propofol in group D decreased more than that in group F (P<0.01).The recovery time in group F decreased more than that in group D (P<0.01).The changes of SBP, DBP and HR were more in group F than those in group D (P<0.05).The incidences of bradycardia, hypotension, apnoea and injec-tion pain in group F were higher than those in group D (P<0.05).At 30 min after PMCT, VRS in group D decreased more than that in group F (P<0.01).The patient’s satisfactions in group F decreased more than that in group D (P<0.05).Conclusions Propofol combined with dexmedemidine or fentanyl provides satisfactory anesthesia for the operation of HCC with ultrasonically guided PMCT, but anesthesia with dexmedemindine increases recovery time and patient’s satisfactions, decreases consumption of propofol and adverse reactions, and has less effect on the respiratory and circulatory function than that with fentanyl.