CAJ | 학술논문

目的：探讨右美托咪定联合胸椎旁神经阻滞应用于乳腺手术的有效性及安全性。方法选择行乳腺手术患者90例,用随机余数法分为三组,每组30例,即右美托咪定组(D组)、咪达唑仑组(M组)和对照组(C组)。 D组与对照组分别于胸椎旁神经阻滞前15 min开始静脉注入等剂量的右美托咪定(负荷量0.5μg/kg、10 min内注完)及生理盐水,M 组于胸椎旁神经阻滞前15 min静脉注入咪达唑仑0.1 mg/kg,观察并记录入室( T0)、胸椎旁神经阻滞穿刺前( T1)、切皮( T2)、肿块切除(T3)、手术结束(T4)时的心率(HR)、呼吸(RR)、平均动脉压(MAP)、SpO2和警觉/镇静评分(OAA/S)。结果与对照组比较,D组T1-T4时MAP明显降低、HR明显减慢；T2、T3时RR明显增快(P<0.05)；D组T2时SpO2明显高于M组和对照组(P<0.05)。 T1-T4时的M组和T1、T2时的D组OAA/S评分明显低于对照组(P<0.05)。结论右美托咪定可安全有效地应用于胸椎旁神经阻滞下乳腺手术的辅助镇静。
목적：탐토우미탁미정연합흉추방신경조체응용우유선수술적유효성급안전성。방법선택행유선수술환자90례,용수궤여수법분위삼조,매조30례,즉우미탁미정조(D조)、미체서륜조(M조)화대조조(C조)。 D조여대조조분별우흉추방신경조체전15 min개시정맥주입등제량적우미탁미정(부하량0.5μg/kg、10 min내주완)급생리염수,M 조우흉추방신경조체전15 min정맥주입미체서륜0.1 mg/kg,관찰병기록입실( T0)、흉추방신경조체천자전( T1)、절피( T2)、종괴절제(T3)、수술결속(T4)시적심솔(HR)、호흡(RR)、평균동맥압(MAP)、SpO2화경각/진정평분(OAA/S)。결과여대조조비교,D조T1-T4시MAP명현강저、HR명현감만；T2、T3시RR명현증쾌(P<0.05)；D조T2시SpO2명현고우M조화대조조(P<0.05)。 T1-T4시적M조화T1、T2시적D조OAA/S평분명현저우대조조(P<0.05)。결론우미탁미정가안전유효지응용우흉추방신경조체하유선수술적보조진정。
Objective To explore the effectiveness and safety of dexmedetomidine combined with thoracic paravertebral blockade in breast surgery. Methods Ninty patients undergoing breast surgery were randomly divided into three groups( n=30 in each group):dexmedetomidine group,midazolam group and control group. The patients were intravenously administered with isodose dexmedetomi-dine(0. 5 μg/kg,finish within 10 min)in dexmedetomidine group,midazolam(0. 1 mg/kg)in midazolam group and normal saline in control group 15 min before thoracic paravertebral blockade respectively. The heart rate(HR),respiration rate(RR),mean arterial pressure( MAP) ,SpO2 and observer assessment of sedation( OAA/S) were recorded before puncture of thoracic paravertebral block-ade( T1 ) ,during skin incision( T2 ) ,during lumpectomy( T3 ) and after surgery( T4 ) . Results Compared with control group,MAP and HR in dexmedetomidine group decreased significantlly from T1 to T4,while RR increased at T2 and T3(P<0. 05). SpO2 was sig-nificantly higher in dexmedetomidine group than those in midazolam group and control group at T2(P<0. 05). OAA/S score in mid-azolam group at T1 -T4 and OAA/S score in dexmedetomidine group at T1 and T2 were significantly lower than those in control group (P<0. 05). Conclusion Dexmedetomidine can be used as a safe and effective auxiliary sedative in breast surgery with thoracic pa-ravertebral blockade.