脑电双频指数引导下右美托咪啶和咪达唑仑用于下肢手术镇静的比较  

Bispectral index-guided intraoperative sedation with dexmedetomidine and midazolam infusion in orthopaedic surgery of lower limbs

作　　者：赵一凡[1] 陈倩茹[2] 胡楚文[1] 曹铭辉[1] 

机构地区：[1]中山大学孙逸仙纪念医院麻醉科,广州510120 [2]中山大学附属中山眼科中心麻醉科,广州510120

出　　处：《国际麻醉学与复苏杂志》2011年第3期281-283,287,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的 比较和评估右美托咪啶（dexmedetomidine，DEX）和咪达唑仑用于骨科下肢手术中镇静的效果和安全性。方法 骨科下肢手术患者52例，均接受腰硬联合麻醉，按镇静方法完全随机分为两组：D组27例，以DEX0．5μg·kg^-1．h^-1静脉恒速输注（负荷量0．5μg／kg）；M组25例，以咪达唑仑50μg·kg^-1.h^-1。静脉恒速输注（负荷量30μg／kg）。两组均将脑电双频指数（bispeetral index，BIS）控制在≤85，并以此为依据相应选择加深镇静或停止输注减浅镇静，同时记录剂量的调整。术中记录呼吸频率（respiration rate，RR）、心率（HR）、脉搏血氧饱和度（pulse oxygen satuation，Sp02）、平均动脉压（MAP），并在术毕停药前评估记录患者的Ramsay镇静评分（RSS评分）。结果 D组的HR（72±7）次／分在用药30min后相比M组（83±8）次份显著减慢（P〈0．05），RR、MAP在各时点差异无统计学意义（P〉0．05）。两组的停药前RSS评分差异无统计学意义（p〉0．05）。D组有6例、M组有7例需要进行剂量调整。另外，M组有5例因舌后坠致SpO2下降需托下颌处理，D组无类似情况。结论 DEX用于骨科下肢手术镇静可引起HR减慢但对血压无明显影响；在相同的镇静程度下，DEX比咪达唑仑更有利于维持呼吸道通畅，可能更适用于该类手术的镇静。Objective To compare and evaluate the effect and safety of dexmedetomidine（DEX） and midazolam sedation in lower limbs orthopaedic surgery. Methods Fifty-two patients undergoing lower limbs surgery were randomly assigned to group D （n=27,DEX, 0.5 μg＇kg^-1.h^-1, loading dose 0.5 μg/kg） and group M（n=25, midazolam, 50 Iμg.kg^-1.h^-1, loading dose 30 μg/kg）. An infusion was administered after mounting a bispectral index （BIS） monitor under combined spinal-epidural anesthesia. The target BIS level was ≤ 85. An additional bolus dose of the study drug or cessation of the infusion was adjusted according to the BIS level, and the change should be recorded. Respiratory rates （RR）, heart rate （HR）, pulse oxygen saturation （SpO2）, mean arterial blood pressure （MAP） were continually monitored. Sedation should be evaluated according to the Ramsay sedation scale（RSS） before the drug withdrawal. Results HR was lower in group D （72±7） bpm than that in group M （83±8） bpm （P〈0.05） 30 min after infusion.. There was no significant difference in the RR, MAP and RSS score between two groups. Dose adjustments were required in six and seven patients Groups D and M, respectively. Five patients needed to raise the mandible due to SpO2 decline by glossocoma in Group M, but none in Group D. Conclusion DEX infusion mildly decreased heart rate in the later periods of lower limbs surgery, with no significant influences on the MAP. Compared with midazolam, DEX might show more advantages in maintaining the unobstructed of the respiratory tract, and be more suitable for sedation in lower limbs surgery.

关 键 词：脑电双频指数 右美托咪啶 咪达唑仑 骨科下肢手术 

分 类 号：R614[医药卫生—麻醉学]