CAJ | 학술논문

目的：探究右美托咪定在喉显微镜手术中的临床应用价值。方法选取进行喉显微外科手术的患者42例，采用随机数字表均分为实验组A 1组、A 2组和对照组B组（n=14）。所有患者在术前常规使用0.5 mg盐酸戊乙奎醚以及10 mg苯巴比妥钠；根据右美托咪定药物动力学效应，于术前15 min对A 1组静脉注射右美托咪定0.5μg/kg，对于A 2组注射右美托咪定1.0μg/kg，对于B组注射等量生理盐水15 mL，注射时间为10 min。麻醉诱导：于术前5 min依次静脉注入0.04 mg/kg咪达唑仑，4μg/kg芬太尼，0.11 mg/kg维库溴铵，2.5 mg/kg丙泊酚。在手术过程中对患者持续注入丙泊酚5 mg/（kg·h）维持镇静，直至手术结束。观察患者进入手术室尚未使用任何麻醉药物时（T 1）、手术开始时（T 2）、手术结束时（T 3）时的心率、镇静程度（Ramsay）评分及平均动脉压。结果（1）在手术中镇静程度的比较，A 1、A 2组明显高于对照组，差异有统计学意义（P＜0.05）；而A 2组T 2、T 3时的镇静程度[（4.88±0.43）分、(4.08±0.56分）]又明显高于A 1组[（4.26±0.46分）、（3.97±0.44分）]，差异有统计学意义（P＜0.05）；（2）手术中患者的心率比较，A 1、A 2组T 2、T 3时明显低于对照组[（83.9±5.2）次/min、（90.2±5.2）次/min）]，差异有统计学意义（P＜0.05）；其中A 2组[（64.5±4.8）次/min、（68.5±4.8）次/min）]又略低于A 1组[（67.7±5.4）次/min、（69.7±4.4）次/min]，差异有统计学意义（P＜0.05）；（3）术中患者的平均动脉压比较，实验组A 1、A 2显著低于对照组，差异有统计学意义（P＜0.05）；其中A 2组[（72.5±7.5）mmHg、（80.2±8.7）mmHg]平均动脉压低A 1组[（74.5±8.1）mmHg、（81.5±7.9）mmHg]，差异有统计学意义（P＜0.05）。结论右美托咪定能够明显提高术中镇静效果，在安全范围内减慢心率，降低血压，使患者的身体状态达到喉显微外科手术的最适麻醉水平，加大喉显微外科手术安全性，对临床具有指导意义。目的：探究右美託咪定在喉顯微鏡手術中的臨床應用價值。方法選取進行喉顯微外科手術的患者42例，採用隨機數字錶均分為實驗組A 1組、A 2組和對照組B組（n=14）。所有患者在術前常規使用0.5 mg鹽痠戊乙奎醚以及10 mg苯巴比妥鈉；根據右美託咪定藥物動力學效應，于術前15 min對A 1組靜脈註射右美託咪定0.5μg/kg，對于A 2組註射右美託咪定1.0μg/kg，對于B組註射等量生理鹽水15 mL，註射時間為10 min。痳醉誘導：于術前5 min依次靜脈註入0.04 mg/kg咪達唑崙，4μg/kg芬太尼，0.11 mg/kg維庫溴銨，2.5 mg/kg丙泊酚。在手術過程中對患者持續註入丙泊酚5 mg/（kg·h）維持鎮靜，直至手術結束。觀察患者進入手術室尚未使用任何痳醉藥物時（T 1）、手術開始時（T 2）、手術結束時（T 3）時的心率、鎮靜程度（Ramsay）評分及平均動脈壓。結果（1）在手術中鎮靜程度的比較，A 1、A 2組明顯高于對照組，差異有統計學意義（P＜0.05）；而A 2組T 2、T 3時的鎮靜程度[（4.88±0.43）分、(4.08±0.56分）]又明顯高于A 1組[（4.26±0.46分）、（3.97±0.44分）]，差異有統計學意義（P＜0.05）；（2）手術中患者的心率比較，A 1、A 2組T 2、T 3時明顯低于對照組[（83.9±5.2）次/min、（90.2±5.2）次/min）]，差異有統計學意義（P＜0.05）；其中A 2組[（64.5±4.8）次/min、（68.5±4.8）次/min）]又略低于A 1組[（67.7±5.4）次/min、（69.7±4.4）次/min]，差異有統計學意義（P＜0.05）；（3）術中患者的平均動脈壓比較，實驗組A 1、A 2顯著低于對照組，差異有統計學意義（P＜0.05）；其中A 2組[（72.5±7.5）mmHg、（80.2±8.7）mmHg]平均動脈壓低A 1組[（74.5±8.1）mmHg、（81.5±7.9）mmHg]，差異有統計學意義（P＜0.05）。結論右美託咪定能夠明顯提高術中鎮靜效果，在安全範圍內減慢心率，降低血壓，使患者的身體狀態達到喉顯微外科手術的最適痳醉水平，加大喉顯微外科手術安全性，對臨床具有指導意義。
목적：탐구우미탁미정재후현미경수술중적림상응용개치。방법선취진행후현미외과수술적환자42례，채용수궤수자표균분위실험조A 1조、A 2조화대조조B조（n=14）。소유환자재술전상규사용0.5 mg염산무을규미이급10 mg분파비타납；근거우미탁미정약물동역학효응，우술전15 min대A 1조정맥주사우미탁미정0.5μg/kg，대우A 2조주사우미탁미정1.0μg/kg，대우B조주사등량생리염수15 mL，주사시간위10 min。마취유도：우술전5 min의차정맥주입0.04 mg/kg미체서륜，4μg/kg분태니，0.11 mg/kg유고추안，2.5 mg/kg병박분。재수술과정중대환자지속주입병박분5 mg/（kg·h）유지진정，직지수술결속。관찰환자진입수술실상미사용임하마취약물시（T 1）、수술개시시（T 2）、수술결속시（T 3）시적심솔、진정정도（Ramsay）평분급평균동맥압。결과（1）재수술중진정정도적비교，A 1、A 2조명현고우대조조，차이유통계학의의（P＜0.05）；이A 2조T 2、T 3시적진정정도[（4.88±0.43）분、(4.08±0.56분）]우명현고우A 1조[（4.26±0.46분）、（3.97±0.44분）]，차이유통계학의의（P＜0.05）；（2）수술중환자적심솔비교，A 1、A 2조T 2、T 3시명현저우대조조[（83.9±5.2）차/min、（90.2±5.2）차/min）]，차이유통계학의의（P＜0.05）；기중A 2조[（64.5±4.8）차/min、（68.5±4.8）차/min）]우략저우A 1조[（67.7±5.4）차/min、（69.7±4.4）차/min]，차이유통계학의의（P＜0.05）；（3）술중환자적평균동맥압비교，실험조A 1、A 2현저저우대조조，차이유통계학의의（P＜0.05）；기중A 2조[（72.5±7.5）mmHg、（80.2±8.7）mmHg]평균동맥압저A 1조[（74.5±8.1）mmHg、（81.5±7.9）mmHg]，차이유통계학의의（P＜0.05）。결론우미탁미정능구명현제고술중진정효과，재안전범위내감만심솔，강저혈압，사환자적신체상태체도후현미외과수술적최괄마취수평，가대후현미외과수술안전성，대림상구유지도의의。
Objective To explore the clinical application value of dexmedetomidine in laryngeal surgery microscope. Methods 42 patients with laryngeal microsurgery surgery were selected and divided into the experimental group A 1, A 2 and the control group B(n=14) by using random number table. In the preoperative period, all patients took 0.5 mg penehyclidine hydrochloride and 10 mg phenobarbital sodium routinely. According pharmacokinetics effect of dexmedetomidine, 15 min before operation, group A 1 was given intravenous injection of dexmedetomidine (0.5μg/kg), group A 2 was given injection of dexmedetomidine (1.0μg/kg), and group B was given injection of saline (15 mL) for 10 minutes. Anesthesia induction: 5 minutes before operation, all patients were given intravenous injection of midazolam (0.04 mg/kg), fentanyl (4μg/kg), vecuronium bromide (0.11 mg/kg), propofol (2.5 mg/kg). During surgery, patients were given continuous injection of propofol 5 mg/(kg?h) to remain calmuntil the end of surgery. Heart rate, sedation score (Ramsay), and mean arterial pressure when patients into the operating room had not used any anesthetic (T 1), surgery at the beginning (T 2), at the end of surgery (T 3) were observed. Results (1) Sedation score of group A 1 and A 2 are higher than that of control group, the difference was statistically significant (P<0.05);Sedation score of group A 2 [(4.88±0.43), (4.08 ±0.56)] group at T 2 and T 3 was higher than the A 1 [(4.26 ±0.46), (3.97±0.44)], the difference was statistically significant (P<0.05);(2) At T 2 and T 3, heart rate of group A 1, A 2 were lower than that of control group [(83.9±5.2), (83.9 ± 5.2)], the differences was statistically significant (P<0.05);heart rate of group A 2 [(64.5± 4.8), (68.5 ±4.8)] was slightly lower than group A 1 [(67.7 ± 5.4), (67.7± 4.4)], the difference was statistically significant(P<0.05);(3) Mean arterial pressure of group A 1 and A 2 was lower than the control group, the difference was statistical significant (P<0.05);mean arterial pressure of A 2 group [(72.5 ± 7.5 ), (72.5±8.7)]was slightly lower A 1 group [(74.5 ±8.1 ), (74.5 ±7.9 mmHg)], the difference was statistically significant(P<0.05). Conclusion Dexmedetomidine can obviously improve the effect of intraoperative sedation, make heart rate slow within the scope of security, reduce blood pressure, make the body stay in the the optimal anesthesia level for laryngeal microsurgical operation, and increase the laryngeal microsurgery operation safety.