CAJ | 학술논문

目的将右美托咪定(dexmedetomidine,Dex)和咪达唑仑分别用于区域麻醉下显微外科手术中镇静,对其效果及安全性进行比较. 方法 60例拟在区域麻醉下行前臂和手部手术的急诊手外科患者,采用随机数字表法将其分为Dex组(D组)和咪达唑仑组(C组),每组30例,应用警觉/镇静评分(observers assessment of alertness/sedation scale,OAA/S)和脑电双频谱指数(bispectral index,BIS)对两组患者术中镇静效果进行观察.两组分别在区域麻醉完善后,D组使用Dex,C组使用咪达唑仑静注至OAA/S镇静深度Ⅲ级并持续泵注维持该镇静水平至术终.观察用药前(T0)、切皮时(T1)、手术开始后15(T2)、30(L)、60 min(T4)、术毕(T5)及术后1 h(T6)患者BIS、平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度的变化;对患者低血压、心动过缓、恶心、呕吐、烦躁等副作用及术中事件的遗忘率进行评估,记录术后血管危象的发生率. 结果 D组泵注Dex后,T1、T2、T3、T4、T5时点HR分别为[(74±14)、(74±13)、(72±12)、(70±11)、(75±11)次/min],较T0时点[(82±15)次/min]显著下降(P＜0.05),D组T1、T2、T3、T4、T5时点MAP分别为[(78±12)、(77±14)、(76±13)、(78±12)、(79±12) mmHg(1 mmHg=0.133 kPa)],较T0 [(87±13) mmHg]明显下降(P＜0.05);C组T1～L时点HR较T0无明显改变(P＞0.05),T1时点MAP [(79±11) mmHg]较T0 [(86±12) mmHg]显著下降(P＜0.05),T2～T5时点MAP和T0比较差异无统计学意义(P＞0.05);组间比较,T1～T4时点D组HR明显低于C组(P＜0.05).Dex产生的镇静效果和咪达唑仑组相似,两组T1～T5时OAA/S评分、BIS与T0比较明显降低(P＜0.05),D组、C组组间各时点OAA/S评分、BIS比较差异无统计学意义(P＞0.05).D组有12例产生完全遗忘,6例不完全遗忘;C组18例产生完全遗忘,9例不完全遗忘,组间比较差异有统计学意义(P＜0.05).两组间术中应用阿托品和麻黄碱例数、呼吸抑制、恶心、呕吐、烦躁及术后血管危象发生率差异无统计学意义(P＞0.05). 结论 Dex和咪达唑仑均适合于区域麻醉下显微外科手术的镇静,在抗交感作用、减少出血、降低心肌耗氧量、镇静、遗忘方面各有优势. 目的將右美託咪定(dexmedetomidine,Dex)和咪達唑崙分彆用于區域痳醉下顯微外科手術中鎮靜,對其效果及安全性進行比較. 方法 60例擬在區域痳醉下行前臂和手部手術的急診手外科患者,採用隨機數字錶法將其分為Dex組(D組)和咪達唑崙組(C組),每組30例,應用警覺/鎮靜評分(observers assessment of alertness/sedation scale,OAA/S)和腦電雙頻譜指數(bispectral index,BIS)對兩組患者術中鎮靜效果進行觀察.兩組分彆在區域痳醉完善後,D組使用Dex,C組使用咪達唑崙靜註至OAA/S鎮靜深度Ⅲ級併持續泵註維持該鎮靜水平至術終.觀察用藥前(T0)、切皮時(T1)、手術開始後15(T2)、30(L)、60 min(T4)、術畢(T5)及術後1 h(T6)患者BIS、平均動脈壓(mean arterial pressure,MAP)、心率(heart rate,HR)、脈搏血氧飽和度的變化;對患者低血壓、心動過緩、噁心、嘔吐、煩躁等副作用及術中事件的遺忘率進行評估,記錄術後血管危象的髮生率. 結果 D組泵註Dex後,T1、T2、T3、T4、T5時點HR分彆為[(74±14)、(74±13)、(72±12)、(70±11)、(75±11)次/min],較T0時點[(82±15)次/min]顯著下降(P＜0.05),D組T1、T2、T3、T4、T5時點MAP分彆為[(78±12)、(77±14)、(76±13)、(78±12)、(79±12) mmHg(1 mmHg=0.133 kPa)],較T0 [(87±13) mmHg]明顯下降(P＜0.05);C組T1～L時點HR較T0無明顯改變(P＞0.05),T1時點MAP [(79±11) mmHg]較T0 [(86±12) mmHg]顯著下降(P＜0.05),T2～T5時點MAP和T0比較差異無統計學意義(P＞0.05);組間比較,T1～T4時點D組HR明顯低于C組(P＜0.05).Dex產生的鎮靜效果和咪達唑崙組相似,兩組T1～T5時OAA/S評分、BIS與T0比較明顯降低(P＜0.05),D組、C組組間各時點OAA/S評分、BIS比較差異無統計學意義(P＞0.05).D組有12例產生完全遺忘,6例不完全遺忘;C組18例產生完全遺忘,9例不完全遺忘,組間比較差異有統計學意義(P＜0.05).兩組間術中應用阿託品和痳黃堿例數、呼吸抑製、噁心、嘔吐、煩躁及術後血管危象髮生率差異無統計學意義(P＞0.05). 結論 Dex和咪達唑崙均適閤于區域痳醉下顯微外科手術的鎮靜,在抗交感作用、減少齣血、降低心肌耗氧量、鎮靜、遺忘方麵各有優勢.
목적 장우미탁미정(dexmedetomidine,Dex)화미체서륜분별용우구역마취하현미외과수술중진정,대기효과급안전성진행비교. 방법 60례의재구역마취하행전비화수부수술적급진수외과환자,채용수궤수자표법장기분위Dex조(D조)화미체서륜조(C조),매조30례,응용경각/진정평분(observers assessment of alertness/sedation scale,OAA/S)화뇌전쌍빈보지수(bispectral index,BIS)대량조환자술중진정효과진행관찰.량조분별재구역마취완선후,D조사용Dex,C조사용미체서륜정주지OAA/S진정심도Ⅲ급병지속빙주유지해진정수평지술종.관찰용약전(T0)、절피시(T1)、수술개시후15(T2)、30(L)、60 min(T4)、술필(T5)급술후1 h(T6)환자BIS、평균동맥압(mean arterial pressure,MAP)、심솔(heart rate,HR)、맥박혈양포화도적변화;대환자저혈압、심동과완、악심、구토、번조등부작용급술중사건적유망솔진행평고,기록술후혈관위상적발생솔. 결과 D조빙주Dex후,T1、T2、T3、T4、T5시점HR분별위[(74±14)、(74±13)、(72±12)、(70±11)、(75±11)차/min],교T0시점[(82±15)차/min]현저하강(P＜0.05),D조T1、T2、T3、T4、T5시점MAP분별위[(78±12)、(77±14)、(76±13)、(78±12)、(79±12) mmHg(1 mmHg=0.133 kPa)],교T0 [(87±13) mmHg]명현하강(P＜0.05);C조T1～L시점HR교T0무명현개변(P＞0.05),T1시점MAP [(79±11) mmHg]교T0 [(86±12) mmHg]현저하강(P＜0.05),T2～T5시점MAP화T0비교차이무통계학의의(P＞0.05);조간비교,T1～T4시점D조HR명현저우C조(P＜0.05).Dex산생적진정효과화미체서륜조상사,량조T1～T5시OAA/S평분、BIS여T0비교명현강저(P＜0.05),D조、C조조간각시점OAA/S평분、BIS비교차이무통계학의의(P＞0.05).D조유12례산생완전유망,6례불완전유망;C조18례산생완전유망,9례불완전유망,조간비교차이유통계학의의(P＜0.05).량조간술중응용아탁품화마황감례수、호흡억제、악심、구토、번조급술후혈관위상발생솔차이무통계학의의(P＞0.05). 결론 Dex화미체서륜균괄합우구역마취하현미외과수술적진정,재항교감작용、감소출혈、강저심기모양량、진정、유망방면각유우세.
Objective To compare the sedative effects and safety of dexmedetomidine (Dex) and midazolam by continuing infusion during microsurgery under regional block.Methods Sixty forearm or hand emergency wounded patients scheduled for microsurgical operation under regional anesthesia were randomly assigned to Dex group (group D) and midazolam group (group C).Observers assessment of alertness/sedation scale (OAA/S) and bispectral index (BIS) values were used to observe the sedative effect of Dex and midazolam during surgery.In all patients,the sedative drugs were intravenously administrated after the completion of regional block anesthesia.Moreover,BIS,mean arterial pressure (MAP),heart rate (HR),oxygen saturation and OAA/S scales were recorded at time-points of before administration (T0),beginning of surgery (T1),15(T2),30(T3),60 min (T4),post-operation instant (T5) and 1 h post-operation (T6).The side effects of patients of the two groups were recorded.The cases of forgetting intraoperative events and the incidence of postoperative vascular crisis were also recorded.Results After administration of Dex,MAP and HR in group D at times of T1-T5 were significantly lower than T0 (P＜0.05).HR at time-points of T1-T5 in group C were no significantly varied (P＞0.05).MAP at time-point of T1 in group C was significantly decreased than T0 (P＜0.05) and MAP at time-points of T2-T5 in group C were not significantly varied (P＞0.05).Comparison between groups,HR at times of T1-T4 in group D was significantly lower than that in group C.The values of BIS and OAA/S at time-points of T1-T5 were all significantly lower than T0 (P＜0.05) in D and C groups.There were no significant differences in BIS and OAA/S at each time point between the two groups (P＞0.05).Twelve cases in group D showed total amnesia and six cases showed un-total amnesia.Eighteen cases in group C showed total amnesia and nine cases showed un-total amnesia.There were significant differences between the two groups (P＜0.05).There were no significant difference between the two groups on the number of cases in application of atropine or ephedrine,incidence of respiratory inhibition,nausea,vomiting,irritability in operation and postoperative vascular crisis (P＞0.05).Conclusions Dex and midazolam can also provide a good sedation with low respiratory inhibition in microsurgery under regional anesthesia.They have their own advantages in anti-sympathetic nerve function,reducing bleeding,reducing myocardial oxygen consumption,sedation and amnesia.