右美托咪啶镇静在成人局麻眼底手术中的应用  

The sedation effect of dexmedetomidine in ophthalmic surgery under local anesthesia

作　　者：李天佐[1] 范雪梅[1] 岳建英[1] 

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,100730

出　　处：《北京医学》2011年第8期643-646,共4页Beijing Medical Journal

摘　　要：目的比较右美托咪啶和丙泊酚用于成人局麻眼底手术的镇静效果和不良反应。方法择期眼底手术患者40例,年龄20～60岁,ASA Ⅰ～Ⅱ级,随机分为右美托咪啶组(D组)和丙泊酚组(P组),每组20例。D组负荷量0.8μg/kg,维持量0.3μg/(kg·h);P组负荷量0.5mg/kg,维持量2.5mg/(kg·h)。负荷量后行球后阻滞。记录入室后5min、局麻前、球后阻滞后3min、手术开始后15min、手术开始后30min、眼底激光操作及手术结束时BIS、HR、MAP、SpO2值,同时进行Ramsay评分。结果 D组HR在局麻操作时、术中较基础值明显降低(P<0.05),也低于相同时点P组HR。D组和P组术中MAP较基础值降低(P<0.05),组间比较无显著性差异。两组术中不同时点镇静评分无显著性差异,D组麻醉后及手术中BIS值低于P组(P<0.05)。D组术中SpO2均在98%以上,大声呼唤均可唤醒,无体动发生;P组术中SpO2最低93%,2例患者需大声呼唤加轻拍手臂唤醒,1例叫醒时头部突然活动。结论成人局麻眼底手术中,右美托咪啶可以产生与丙泊酚相似的镇静效果,且易唤醒、无呼吸抑制,更适用于眼底手术中镇静。Objective To evaluate the sedative effect of dexmedetomidine and propofol and the correlation of the conscious condition and BIS in ophthalmic surgery.Methods Forty patients,ASA Ⅰ～Ⅱ,who underwent elective ophthalmic surgery,were randomly divided into two groups based on the medications used for sedation：the dexmedetomidine group（Group D） and the propofol group（Group P）.In Group D,the loading dose was 0.8 μg/kg,followed by 0.3 μg/（kg·h）.In Group P,the loading dose was 0.5 mg/kg,followed by 2.5 mg/（kg·h）.BIS,HR,MAP and Ramsay score were observed and recorded before and during the operation.Results The Ramsay scores were same in the two groups and BIS were lower in Group D compared with Group P（P 0.05）.HR in Group D was also lower than Group P（P 0.05）.Side effects of hopoxemia were observed only in Group P.Conclusion Compared with propofol,dexmedetomidine appears to have more advantages in patients with ophthalmic surgery under local anesthesia.In addition,the BIS is lower with dexmedetomidine sedation than propofol at the same sedative level.

关 键 词：右美托咪啶 脑电双频指数 RAMSAY评分 丙泊酚 

分 类 号：R614[医药卫生—麻醉学]