中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
33期
2667-2670
,共4页
李京生%田肇隆%兰飞%王天龙
李京生%田肇隆%蘭飛%王天龍
리경생%전조륭%란비%왕천룡
帕金森病%镇痛%镇静%微电生理监测%右美托咪定
帕金森病%鎮痛%鎮靜%微電生理鑑測%右美託咪定
파금삼병%진통%진정%미전생리감측%우미탁미정
Parkinson's disease%Dexmedetomidine%Analgesia%Conscious sedation%Electrophysiological processes
目的 观察右美托咪定(Dex)用于帕金森(PD)患者脑核团毁损术的效果以及对术中脑核团的微电生理监测(MER)的影响,探求Dex在脑核团毁损术监测麻醉的最佳使用剂量.方法 选择2012年1至6月宣武医院功能神经外科拟行脑核团毁损术的PD患者60例,经医院伦理委员会审核通过,数字表法随机分为3组(每组20例),A组:患者不使用任何麻醉镇静剂,B组:患者给予Dex负荷量0.3μg/kg静脉输注(持续时间15 min),维持量0.3 μg· kg-1·h-1;C组:Dex负荷量0.5 μg/kg(持续时间15 min),维持量0.3 μg· kg-1·h-1.分别记录入室(基础值)、给药后5 min(T1)、10 min(T2)、15 min(T3)、20 min(T4)、30 min(T5)及60 min(T6)的平均动脉压、心率、经鼻呼气末二氧化碳分压(PETC02)、呼吸频率、脉搏血氧饱和度及OAA/S和VRS评分.结果 与人室相比,B、C组心率减慢、呼吸次数减少,C组PET C02升高.3组患者术中血压均控制良好.A组患者VRS评分≥1比例明显高于B、C两组,而C组患者OAA/S评分＞1比例明显高于A、B两组.C组有2例(10％)患者脑核团的MER监测受到影响.结论 入室后给予PD患者Dex负荷剂量0.3μg/kg,维持剂量0.3 μg·kg-1·h-1,对手术及脑核团的MER影响不明显,对呼吸影响较小,有一定的镇静镇痛及降压作用,适合用于PD患者脑核团毁损术的监测麻醉.
目的 觀察右美託咪定(Dex)用于帕金森(PD)患者腦覈糰燬損術的效果以及對術中腦覈糰的微電生理鑑測(MER)的影響,探求Dex在腦覈糰燬損術鑑測痳醉的最佳使用劑量.方法 選擇2012年1至6月宣武醫院功能神經外科擬行腦覈糰燬損術的PD患者60例,經醫院倫理委員會審覈通過,數字錶法隨機分為3組(每組20例),A組:患者不使用任何痳醉鎮靜劑,B組:患者給予Dex負荷量0.3μg/kg靜脈輸註(持續時間15 min),維持量0.3 μg· kg-1·h-1;C組:Dex負荷量0.5 μg/kg(持續時間15 min),維持量0.3 μg· kg-1·h-1.分彆記錄入室(基礎值)、給藥後5 min(T1)、10 min(T2)、15 min(T3)、20 min(T4)、30 min(T5)及60 min(T6)的平均動脈壓、心率、經鼻呼氣末二氧化碳分壓(PETC02)、呼吸頻率、脈搏血氧飽和度及OAA/S和VRS評分.結果 與人室相比,B、C組心率減慢、呼吸次數減少,C組PET C02升高.3組患者術中血壓均控製良好.A組患者VRS評分≥1比例明顯高于B、C兩組,而C組患者OAA/S評分＞1比例明顯高于A、B兩組.C組有2例(10％)患者腦覈糰的MER鑑測受到影響.結論 入室後給予PD患者Dex負荷劑量0.3μg/kg,維持劑量0.3 μg·kg-1·h-1,對手術及腦覈糰的MER影響不明顯,對呼吸影響較小,有一定的鎮靜鎮痛及降壓作用,適閤用于PD患者腦覈糰燬損術的鑑測痳醉.
목적 관찰우미탁미정(Dex)용우파금삼(PD)환자뇌핵단훼손술적효과이급대술중뇌핵단적미전생리감측(MER)적영향,탐구Dex재뇌핵단훼손술감측마취적최가사용제량.방법 선택2012년1지6월선무의원공능신경외과의행뇌핵단훼손술적PD환자60례,경의원윤리위원회심핵통과,수자표법수궤분위3조(매조20례),A조:환자불사용임하마취진정제,B조:환자급여Dex부하량0.3μg/kg정맥수주(지속시간15 min),유지량0.3 μg· kg-1·h-1;C조:Dex부하량0.5 μg/kg(지속시간15 min),유지량0.3 μg· kg-1·h-1.분별기록입실(기출치)、급약후5 min(T1)、10 min(T2)、15 min(T3)、20 min(T4)、30 min(T5)급60 min(T6)적평균동맥압、심솔、경비호기말이양화탄분압(PETC02)、호흡빈솔、맥박혈양포화도급OAA/S화VRS평분.결과 여인실상비,B、C조심솔감만、호흡차수감소,C조PET C02승고.3조환자술중혈압균공제량호.A조환자VRS평분≥1비례명현고우B、C량조,이C조환자OAA/S평분＞1비례명현고우A、B량조.C조유2례(10％)환자뇌핵단적MER감측수도영향.결론 입실후급여PD환자Dex부하제량0.3μg/kg,유지제량0.3 μg·kg-1·h-1,대수술급뇌핵단적MER영향불명현,대호흡영향교소,유일정적진정진통급강압작용,괄합용우PD환자뇌핵단훼손술적감측마취.
Objective To observe the sedative and analgesic effects of dexmedetomidine (Dex) and its influence on respiration and blood pressure,evaluate electrophysiological monitoring and explore the optimal dose of Dex for brain nuclei lesion in Parkinson's disease (PD) patients.Methods Approved by hospital ethics committee,60 PD patients undergoing brain nuclei lesion ablation were randomly allocated into 3 groups (n =20 each).No sedative anesthetic was used in group A; In group B,Dex 0.3 μg/kg intravenously for initial bolus (duration 15 min) and then 0.3 μg · kg-1 · h-1 continuous infusion; In group C,Dex 0.5 μg/kg intravenously (duration 15 min) for initial load and then 0.3 μg · kg-1 · h-1 continuous infusion.The parameters of mean arterial pressure (MAP),heart rate (HR),pressure of end-tidal carbon dioxide (PETCO2),respiratory rate,blood oxygen saturation (SpO2),observer's assessment of alertness/ sedation (OAA/S) and verbal rating score (VRS) were recorded at 0 min (baseline),5 min (T1),10 min (T2),15 min (T3),20 min (T4),30 min (T5) and60 min (T6) after the dosing of Dex.Results HR and respiratory rate decreased in groups B and C compared with baseline.In group C,PETCO2 was much higher,compared with baseline (P ＜ 0.05).Blood pressures of three groups were well-controlled.The incidence of pain (VRS ≥ 1) in group A was significantly higher than those of groups B and C (P ＜ 0.05).And the incidence of sedation (OAA/S ＞ 1) in group C was much higher than those of groups A and B.The electrophysiological signal of two patients in group C was severely affected.Conclusion At an initial intravenous dose of Dex 0.3 μg/kg and a maintenance dose of 0.3 μg · kg-1 · h-1,electrophysiological monitoring for surgery is not affected in PD patients undergoing brain nuclei lesion ablation.With a minimal interference of breath,Dex has not only well-controlled effects on sedation,analgesia and blood pressure,but also makes patients comfortable.
