CAJ | 학술논문

目的确定下肢手术患者右美托咪定和咪达唑仑扩张外周血管作用的程度.方法择期硬膜外麻醉下行下肢手术患者100例,性别不限,年龄27～64岁,BMI 20 ～30 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,分为4组(n=25):右美托咪定组(D组)、补偿性扩容+右美托咪定组(CVE+D组)、眯达唑仑组(M组)和补偿性扩容+咪达唑仑组(CVE+M组).D组和CVE+D组经5 min静脉输注右美托咪定负荷剂量0.5 μg/kg,随后以0.3～0.6 μg· kg-1·h-1速率输注;M组和CVE+M组经5 min静脉输注咪达唑仑0.05 mg/kg,随后以0.03～0.10 μg· kg-1·h-1速率输注,4组均输注至警觉/镇静评分达到3分.CVE+D组和CVE+M组在输注右美托咪定和咪达唑仑的同时开始补偿性扩容,静脉输注6％羟乙基淀粉130/0.4氯化钠溶液0.5 ml·kg-1·min-1,输注剂量7 ml/kg.分别于输注右美托咪定或咪达唑仑前和警觉/镇静评分达到3分时采集动脉血样,测定血糖浓度,然后静脉注射50％葡萄糖10 ml,注射后3 min时再次采集动脉血样,测定血糖浓度,根据葡萄糖初始分布容积确定葡萄糖稀释程度,以反映扩张外周血管程度.结果 D组、CVE+D组、M组和CVE+M组扩张外周血管程度分别为(8.5±0.5)％、(8.4±0.4)％、(0.9±0.5)％和(0.8±0.5)％,D组和CVE+D组间及M组和CVE+M组间扩张外周血管程度比较差异无统计学意义(P＞0.05).结论下肢手术患者右美托咪定扩张外周血管的程度约为8.5％,咪达唑仑扩张外周血管的程度仅约为0.9％.
목적 학정하지수술환자우미탁미정화미체서륜확장외주혈관작용적정도.방법 택기경막외마취하행하지수술환자100례,성별불한,년령27～64세,BMI 20 ～30 kg/m2,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,분위4조(n=25):우미탁미정조(D조)、보상성확용+우미탁미정조(CVE+D조)、미체서륜조(M조)화보상성확용+미체서륜조(CVE+M조).D조화CVE+D조경5 min정맥수주우미탁미정부하제량0.5 μg/kg,수후이0.3～0.6 μg· kg-1·h-1속솔수주;M조화CVE+M조경5 min정맥수주미체서륜0.05 mg/kg,수후이0.03～0.10 μg· kg-1·h-1속솔수주,4조균수주지경각/진정평분체도3분.CVE+D조화CVE+M조재수주우미탁미정화미체서륜적동시개시보상성확용,정맥수주6％간을기정분130/0.4록화납용액0.5 ml·kg-1·min-1,수주제량7 ml/kg.분별우수주우미탁미정혹미체서륜전화경각/진정평분체도3분시채집동맥혈양,측정혈당농도,연후정맥주사50％포도당10 ml,주사후3 min시재차채집동맥혈양,측정혈당농도,근거포도당초시분포용적학정포도당희석정도,이반영확장외주혈관정도.결과 D조、CVE+D조、M조화CVE+M조확장외주혈관정도분별위(8.5±0.5)％、(8.4±0.4)％、(0.9±0.5)％화(0.8±0.5)％,D조화CVE+D조간급M조화CVE+M조간확장외주혈관정도비교차이무통계학의의(P＞0.05).결론 하지수술환자우미탁미정확장외주혈관적정도약위8.5％,미체서륜확장외주혈관적정도부약위0.9％.
Objective To evaluate the degree of peripheral vasodilation induced by dexmedetomidine and midazolam in the patients undergoing lower extremity surgery.Methods One hundred patients of both sexes, aged 27-64 yr, with body mass index of 20-30 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective lower extremity surgery under epidural anesthesia, were randomly divided into 4 groups (n =25 each) : dexmedetomidine group (group D), compensatory volume expansion+dexmedetomidine group (group CVE+D), midazolam group (group M) , and compensatory volume expansion + midazolam group (group CVE+M).In D and CVE+D groups, dexmedetomidine was infused over 5 min in a loading dose of 0.5 μg/kg, followed by an infusion of 0.3-0.6 μg· kg-1 · h-1 until Observer's Assessment of Alertness/Sedation (OAA/S) score reached 3.In M and CVE+M groups, midazolam was injected over 5 min in a dose of 0.05 mg/kg, followed by an infusion of 0.03-0.10 μg · kg-1 · h-1 until OAA/S score reached 3.In CVE+D and CVE+M groups, compensatory volume expansion was performed at the same time as dexmedetomidine and midazolam were infused, 6％ hydroxyethyl starch 130/0.4 and sodium chloride solution was infused intravenously at a rate of 0.5 ml · kg-1 · min-1, and the total volume infused was 7 ml/kg.Before injection of dexmedetomidine or midazolam, and when OAA/S score reached 3, arterial blood samples were collected to determine the blood glucose concentration.Then 50％ glucose 10 ml was injected intravenously, and 3 min later, arterial blood samples were collected again to determine the blood glucose concentration.According to the initial distribution volume of glucose, the degree of glucose dilution was determined to reflect the degree of peripheral vasodilation.Results The degree of peripheral vasodilation was (8.5±0.5)％, (8.4±0.4) ％,(0.9±0.5)％ and (0.8±0.5)％ in D, CVE+D, M and CVE+M groups, respectively.There was no significant difference in the degree of peripheral vasodilation between D and CVE+D groups, and between M and CVE+M groups.Conclusion The degree of peripheral vasodilation induced by dexmedetomidine is about 8.5％, and by midazolam is only about 0.9％ in the patients undergoing lower extremity surgery.