中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
21期
5-8
,共4页
王维%隋波%李冠华%李永旺%王国经
王維%隋波%李冠華%李永旺%王國經
왕유%수파%리관화%리영왕%왕국경
右美托咪啶%麻醉%高强度聚焦超声消融%胰腺肿瘤
右美託咪啶%痳醉%高彊度聚焦超聲消融%胰腺腫瘤
우미탁미정%마취%고강도취초초성소융%이선종류
Dexmedetomidine%Anesthesia%High-intensity focused ultrasound ablation%Pancreatic neoplasms
目的 评价右美托咪定在全身麻醉下胰腺癌高强度聚焦超声(HIFU)治疗中的作用.方法 选择择期胰腺癌HIFU治疗患者120例,ASA分级Ⅱ～Ⅲ级,将患者按随机数字表法分为对照组(C组)和右美托咪定组(D组),每组60例.D组麻醉诱导前15 min经静脉输注右美托咪定负荷量0.7μg/kg,随后以0.2μg/(kg·h)的速率静脉输注至术毕,C组给予等容量0.9％氯化钠.两组负荷量输注完毕后5 min均静脉注射芬太尼2～3μg/kg、丙泊酚1.5～ 2.0 mg/kg和顺阿曲库铵0.2 mg/kg麻醉诱导,麻醉维持采用七氟烷、雷米芬太尼、丙泊酚、顺阿曲库铵.记录两组丙泊酚、雷米芬太尼和七氟烷用量,术后躁动、谵妄、苏醒延迟的发生情况.结果 D组术中心率均低于C组,差异有统计学意义(P＜0.05).D组丙泊酚、雷米芬太尼和七氟烷用量均少于C组[(341.4±45.7) mg比(520.5±50.8)mg、(1.7±0.5) mg比(2.3±0.8)mg、(11.6±4.1) ml比(16.7±3.8) ml],差异有统计学意义(P＜0.05).D组术后躁动和谵妄发生率低于C组[6.7％(4/60)比21.7％(13/60)和8.3％(5/60)比26.7％(16/60)],差异有统计学意义(P＜0.05)；D组和C组术后苏醒延迟发生率比较差异无统计学意义[3.3％(2/60)比1.7％(1/60),P＞0.05].结论 右美托咪定可减少胰腺癌HIFU治疗患者全身麻醉药用量,降低术后躁动和谵妄发生率,降低术中心率.
目的 評價右美託咪定在全身痳醉下胰腺癌高彊度聚焦超聲(HIFU)治療中的作用.方法 選擇擇期胰腺癌HIFU治療患者120例,ASA分級Ⅱ～Ⅲ級,將患者按隨機數字錶法分為對照組(C組)和右美託咪定組(D組),每組60例.D組痳醉誘導前15 min經靜脈輸註右美託咪定負荷量0.7μg/kg,隨後以0.2μg/(kg·h)的速率靜脈輸註至術畢,C組給予等容量0.9％氯化鈉.兩組負荷量輸註完畢後5 min均靜脈註射芬太尼2～3μg/kg、丙泊酚1.5～ 2.0 mg/kg和順阿麯庫銨0.2 mg/kg痳醉誘導,痳醉維持採用七氟烷、雷米芬太尼、丙泊酚、順阿麯庫銨.記錄兩組丙泊酚、雷米芬太尼和七氟烷用量,術後躁動、譫妄、囌醒延遲的髮生情況.結果 D組術中心率均低于C組,差異有統計學意義(P＜0.05).D組丙泊酚、雷米芬太尼和七氟烷用量均少于C組[(341.4±45.7) mg比(520.5±50.8)mg、(1.7±0.5) mg比(2.3±0.8)mg、(11.6±4.1) ml比(16.7±3.8) ml],差異有統計學意義(P＜0.05).D組術後躁動和譫妄髮生率低于C組[6.7％(4/60)比21.7％(13/60)和8.3％(5/60)比26.7％(16/60)],差異有統計學意義(P＜0.05)；D組和C組術後囌醒延遲髮生率比較差異無統計學意義[3.3％(2/60)比1.7％(1/60),P＞0.05].結論 右美託咪定可減少胰腺癌HIFU治療患者全身痳醉藥用量,降低術後躁動和譫妄髮生率,降低術中心率.
목적 평개우미탁미정재전신마취하이선암고강도취초초성(HIFU)치료중적작용.방법 선택택기이선암HIFU치료환자120례,ASA분급Ⅱ～Ⅲ급,장환자안수궤수자표법분위대조조(C조)화우미탁미정조(D조),매조60례.D조마취유도전15 min경정맥수주우미탁미정부하량0.7μg/kg,수후이0.2μg/(kg·h)적속솔정맥수주지술필,C조급여등용량0.9％록화납.량조부하량수주완필후5 min균정맥주사분태니2～3μg/kg、병박분1.5～ 2.0 mg/kg화순아곡고안0.2 mg/kg마취유도,마취유지채용칠불완、뢰미분태니、병박분、순아곡고안.기록량조병박분、뢰미분태니화칠불완용량,술후조동、섬망、소성연지적발생정황.결과 D조술중심솔균저우C조,차이유통계학의의(P＜0.05).D조병박분、뢰미분태니화칠불완용량균소우C조[(341.4±45.7) mg비(520.5±50.8)mg、(1.7±0.5) mg비(2.3±0.8)mg、(11.6±4.1) ml비(16.7±3.8) ml],차이유통계학의의(P＜0.05).D조술후조동화섬망발생솔저우C조[6.7％(4/60)비21.7％(13/60)화8.3％(5/60)비26.7％(16/60)],차이유통계학의의(P＜0.05)；D조화C조술후소성연지발생솔비교차이무통계학의의[3.3％(2/60)비1.7％(1/60),P＞0.05].결론 우미탁미정가감소이선암HIFU치료환자전신마취약용량,강저술후조동화섬망발생솔,강저술중심솔.
Objective To investigate the effect of dexmedetomidine on patients with pancreatic cancer treated by high intensity focused ultrasound (HIFU) under general anesthesia.Methods One hundred and twenty ASA Ⅱ or Ⅲ patients with pancreatic cancer undergoing HIFU treatment,were divided into control group (group C) and dexmedetomidine group (group D) by random digits table method,each group with 60 cases.Dexmedetomidine was intravenously infused at 0.2 μ g/(kg· h) until the end of operation after a loading dose of 0.7 μg/kg over 15 min before induction of anesthesia in group D,while the equal volume of normal saline was infused in group C.Anesthesia was induced with intravenous injection of fentanyl 2-3 μg/kg and propofol 1.5-2.0 mg/kg and cisatracurium 0.2 mg/kg at 5 min after administration of the loading dose.Anesthesia was maintained with sevoflurane,remifentanil,propofol,cisatracurium.The propofol,remifentanil and sevoflurane consumption,the incidence of postoperative agitation,delirium,delayed recovery were recorded.Results The intraoperative heart rate in group D was significantly lower than that in group C (P ＜ 0.05).The propofol,remifentanil and sevoflurane consumption in group D were significantly shorter than those in group C [(341.4 ± 45.7) mg vs.(520.5 ± 50.8) mg,(1.7 ± 0.5) mg vs.(2.3 ± 0.8) mg,(11.6 ± 4.1) ml vs.(16.7 ± 3.8) ml,P ＜ 0.05].The incidence of postoperative agitation and delirium in group D were significantly lower than those in group C [6.7％(4/60) vs.21.7％(13/60),8.3％ (5/60) vs.26.7％ (16/60),P ＜ 0.05].There was no statistically significant difference in the incidence of delayed recovery between group D and group C [3.3％ (2/60) vs.1.7％ (1/60),P ＞ 0.05].Conclusions Dexmedetomidine given HIFU treatment of pancreatic cancer patients can reduce the amount of general anesthetic,reduce the incidence of postoperative agitation and delirium,intraoperative heart rate.
