CAJ | 학술논문

目的观察右美托咪定用于全脑血管造影检查的镇静效果,探讨其安全性和最佳使用剂量.方法选择75例择期行全脑血管造影检查患者,按随机数字表法分为A、B、C三组,每组25例.三组在手术开始10 min内用微量泵恒速泵入右美托咪定负荷量0.5 μ g/kg,随后A、B、C组分别以0.3、0.5、0.7μg/(kg·h)的速度维持输注,在手术结束前10 min停止输注.记录三组患者给药即刻(T0)、给药后10 min(T1)、给药后20 min(T2)、给药后30 min(T3)、术后10 min(T4)的心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、Ramsay镇静评分;记录各组造影过程中出现体动反应及需要人工干预的例数;比较术中记忆遗忘程度.结果三组T1～T3时MAP、心率均低于本组T0,差异有统计学意义(P＜0.05),T4时恢复至T0水平,差异无统计学意义(P＞0.05);C组T2、T3时MAP、心率均低于同期A组和B组,差异有统计学意义(P＜0.05).三组T1～ T3时Ramsay镇静评分均高于本组T0,差异有统计学意义(P＜0.05);B、C组T2、T3时Ramsay镇静评分高于A组,差异有统计学意义(P＜0.05),但C组有5例患者在T2、T3时出现镇静过度(5～6分).三组各时间点SpO2组间和组内比较差异均无统计学意义(P＞0.05).B、C组术中出现不自主体动反应的例数明显少于A组(5、3例比10例),A、C组术中需要干预的例数明显多于B组(8、10例比3例),B、C组遗忘程度为Ⅲ级率明显高于A组[64％(16/25)、72％(18/25)比40％(10/25)],差异均有统计学意义(P＜0.05).结论静脉泵入右美托咪定0.5μg/kg后以0.5 μ(kg·h)维持输注在全脑血管造影检查中可以获得较好的镇静效果,生命体征平稳,改善患者舒适度,患者术中不良记忆少,是适用于全脑血管造影检查的安全合适的镇静剂量.
목적 관찰우미탁미정용우전뇌혈관조영검사적진정효과,탐토기안전성화최가사용제량.방법 선택75례택기행전뇌혈관조영검사환자,안수궤수자표법분위A、B、C삼조,매조25례.삼조재수술개시10 min내용미량빙항속빙입우미탁미정부하량0.5 μ g/kg,수후A、B、C조분별이0.3、0.5、0.7μg/(kg·h)적속도유지수주,재수술결속전10 min정지수주.기록삼조환자급약즉각(T0)、급약후10 min(T1)、급약후20 min(T2)、급약후30 min(T3)、술후10 min(T4)적심솔、평균동맥압(MAP)、맥박혈양포화도(SpO2)、Ramsay진정평분;기록각조조영과정중출현체동반응급수요인공간예적례수;비교술중기억유망정도.결과 삼조T1～T3시MAP、심솔균저우본조T0,차이유통계학의의(P＜0.05),T4시회복지T0수평,차이무통계학의의(P＞0.05);C조T2、T3시MAP、심솔균저우동기A조화B조,차이유통계학의의(P＜0.05).삼조T1～ T3시Ramsay진정평분균고우본조T0,차이유통계학의의(P＜0.05);B、C조T2、T3시Ramsay진정평분고우A조,차이유통계학의의(P＜0.05),단C조유5례환자재T2、T3시출현진정과도(5～6분).삼조각시간점SpO2조간화조내비교차이균무통계학의의(P＞0.05).B、C조술중출현불자주체동반응적례수명현소우A조(5、3례비10례),A、C조술중수요간예적례수명현다우B조(8、10례비3례),B、C조유망정도위Ⅲ급솔명현고우A조[64％(16/25)、72％(18/25)비40％(10/25)],차이균유통계학의의(P＜0.05).결론 정맥빙입우미탁미정0.5μg/kg후이0.5 μ(kg·h)유지수주재전뇌혈관조영검사중가이획득교호적진정효과,생명체정평은,개선환자서괄도,환자술중불량기억소,시괄용우전뇌혈관조영검사적안전합괄적진정제량.
Objective To observe the sedative effectiveness of dexmedetomidine (DEX) in digital subtraction angiography (DSA),and to investigate the optimal and safe administration dose.Methods Seventy-five patients undergoing DSA were divided into three groups by random digits table with 25 cases each group.Three groups were treated with constant infusion of DEX by micro-pump 10 min before surgery with the same dose of saline.Then group A,B,C respectively were given 0.3,0.5,0.7 μg/ (kg·h) of the maintenance infusion rate,and stop infusion 10 min before the end of the surgery.At administration (T0),10 (T1),20 (T2) and 30 (T3) min after administration,10 min after surgery (T4),the heart rate (HR),mean arterial pressure (MAP),peripheral oxygen saturation (SpO2),Ramsay score,number of cases that appeared body movement were recorded,and their forgotten degree of operating memory were compared.Results The HR,MAP in three groups at T1-T3 was significandy lower than that at T0 (P＜ 0.05),T4 levels returned to T0 (P＞ 0.05).The HR,MAP in group C at T2,T3 was significantly lower than that in group A and group B at the same time (P ＜ 0.05).The Ramsay score in three groups at T2,T3 was significantly higher than that at T0(P ＜0.05),group B and group C at T2,T3 was significantly higher than that in group A at the same time (P ＜0.05).The SpO2 in three groups at each time point compared within and among groups was no significant difference (P ＞ 0.05).Group B and group C intraoperative involuntary movement in response patients were significantly less than in group A (5,3 cases vs.10 cases).Group A and group C surgery requires intervention patients was significantly more than in group B (8,10 cases vs.3 cases).Group B and group C amnesia grade Ⅲ rate was significantly higher than that in group A [64％ (16/25),72％ (18/25) vs.40％(10/25),P ＜ 0.05].Conclusion Infusion with 0.5 μ g/(kg· h) DEX 10 min after intravenous injection with 0.5 μ g/kg can get a better sedative effect,stable vital signs and less intraoperative adverse memory,and it can also improve patients' comfortable degree,which is safe and appropriate sedative dosage in DSA.