CAJ | 학술논문

目的：评价右美托咪定用于局麻下甲状腺手术患者清醒镇静的效果。方法：择期拟行甲状腺手术患者80例随机分为对照组（n＝40）和研究组（n＝40），研究组静脉注射右美托咪定，负荷量0．5μg／kg，再以0．6μg·kg－1·h－1的速率持续静脉输注，对照组给予同容量的生理盐水。手术开始时由术者以1％普鲁卡因术野局部浸润麻醉。术中两组患者每20 min 间断追加芬太尼0．5μg／kg，必要时重复。记录两组手术时间、术中BP、HR 和SpO2的变化情况及辅助使用芬太尼的剂量。记录入室时（T1）、手术开始时（T2）、手术开始后30 min（T3）、手术结束时（T4）测定血糖的变化。以Ramsay 镇静评分法评价患者的镇静程度。结果：两组患者均无呼吸抑制，术中研究组患者Ramsay 镇静评分为3－4分，对照组患者Ramsay 镇静评分为2分，两组患者均能呼之则应，保持发声。与对照组比较，研究组在 T2、T3、T4等时间点血糖明显降低（P＜0．05）；研究组术中心动过速及高血压发生率明显低于对照组（P＜0．05），术中芬太尼使用量明显降低（P＜0．05）。结论：右美托咪定用于局麻下甲状腺手术患者清醒镇静的效果良好。
목적：평개우미탁미정용우국마하갑상선수술환자청성진정적효과。방법：택기의행갑상선수술환자80례수궤분위대조조（n＝40）화연구조（n＝40），연구조정맥주사우미탁미정，부하량0．5μg／kg，재이0．6μg·kg－1·h－1적속솔지속정맥수주，대조조급여동용량적생리염수。수술개시시유술자이1％보로잡인술야국부침윤마취。술중량조환자매20 min 간단추가분태니0．5μg／kg，필요시중복。기록량조수술시간、술중BP、HR 화SpO2적변화정황급보조사용분태니적제량。기록입실시（T1）、수술개시시（T2）、수술개시후30 min（T3）、수술결속시（T4）측정혈당적변화。이Ramsay 진정평분법평개환자적진정정도。결과：량조환자균무호흡억제，술중연구조환자Ramsay 진정평분위3－4분，대조조환자Ramsay 진정평분위2분，량조환자균능호지칙응，보지발성。여대조조비교，연구조재 T2、T3、T4등시간점혈당명현강저（P＜0．05）；연구조술중심동과속급고혈압발생솔명현저우대조조（P＜0．05），술중분태니사용량명현강저（P＜0．05）。결론：우미탁미정용우국마하갑상선수술환자청성진정적효과량호。
Objective: To evaluate the efficacy of conscious sedation with dexmedetomidine combined with infiltration anaesthesia in patients undergoing subtotal thyroidectomy . Methods: 80 patients underwent subtotal thyroidectomy were randomly assigned into control group(n=40,group C) and dexmedetomidine group(n=40,group D). Dexmedetomidine was infused at a rate of 0.6 μg·kg-1·h-1 after a loading dose of 0.5 μg/kg in group D. In group C, normal soline of the same volume as group D was infused. Both groups were infiltrated with 1% procaine at the beginning of operation. A bolus of fentanyl 0.5 μg/kg was injected every 20 min and repeated according to need. Duration of operation,BP,HR,SpO2 and amount of fentanyl were recorded. Blood glucose was detected after admission to the operating room (T1), at the beginning of operation(T2), at 30 min afer skin incision(T3), at the end of operation(T4). The degree of sedation was evaluated with Ramsay sedation score. Results: There were no adverse respiratory events seen in either group C or D. Ramsay Sedation Scale score was 3-4 in group D, 2 in group C respectively. Both groups were kept voicing and painless and easily woken up. Compared with group C,blood glucose level was significantly lower at T2-4 in group D (P<0.05), the incidence of hypertension, tachycardia and amount of fentanyl were significantly decreased in group D (P<0.05). Conclusion: When combined with infiltration anaesthesia, dexmedetomidine can provide satisfactory efficacy of conscious sedation for subtotal thyroidectomy.