右美托咪啶用于脑功能区手术术中唤醒麻醉的观察  

Clinical observation of dexmedetomidine for conscious sedation in awake craniotomy on cerebral functional area

作　　者：沈社良[1] 王文元[1] 胡双飞[1] 楼小侃[1] 

机构地区：[1]浙江省人民医院麻醉科,杭州310014

出　　处：《中国临床药学杂志》2013年第3期133-137,共5页Chinese Journal of Clinical Pharmacy

基　　金：浙江省医学会临床科研基金(编号2010ZYC-A04)

摘　　要：目的观察右美托咪啶应用于脑功能区手术术中唤醒麻醉的有效性及安全性。方法 15例择期脑功能区(运动区病灶)手术患者,麻醉诱导为丙泊酚靶控输注(Cp 4 mg·L^(-1))、顺苯磺酸阿曲库铵、瑞芬太尼(Cp 3μg·L^(-1))。气管插管后2 min,丙泊酚Cp调整为2.5 mg·L^(-1),瑞芬太尼Cp调整为2μg·L^(-1),先在10 min内缓慢泵入右美托咪啶负荷量1μg·kg^(-1),然后以0.2~0.7μg·kg^(-1)·h^(-1)维持。右美托咪啶负荷量输注结束时,停止丙泊酚TCI。外科医师在手术开始时拟定唤醒时间点(T_0),在T_0前10 min瑞芬太尼Cp减少为0.5μg·L^(-1),右美托咪啶减少为0.2μg·kg^(-1)·h^(-1)。患者自主呼吸恢复后,若能按指令活动双手及双足,即视其为清醒。观察唤醒时间、唤醒质量、唤醒期间不良事件、围唤醒期生命体征以及术终即刻外科医师和术后第2天随访时患者对术中唤醒实施过程的满意度。结果唤醒时间(11.5±3.7)min;唤醒质量Ⅰ级加Ⅱ级93.3%;唤醒期间不良事件平均发生率6.67%;外科医师和患者对术中唤醒实施过程的满意度分别为(96.8±4.6)分和(90.4±5.9)分。结论右美托咪啶可安全有效地应用于脑功能区手术术中唤醒麻醉,具有唤醒时间短,唤醒质量高,唤醒期间不良事件发生率低,外科医师及患者对术中唤醒实施过程满意度高等优点。AIM To observe the efficacy and safety of dexmedetomidine for conscious sedation in awake cranioto my on cerebral functional area. METHODS In 15 patients of ASA I -11 scheduled for awake craniotomy, 2 min after tracheal intubation, propofol was discontinued, and dexmedetomidine was administrated 1.0 ttg＇kg-1 followed by a con tinuous infusion of 0.2 - 0.7 ug^. kg- 1. h- 1. The surgeon preseted the anticipated awake point preoperatively （T0）, 10 min before To, dexmedetomidine was reduced to 0.2 ug. kg- 1. h- 1. Arousal time, quality of awakening and adverse events in wake-up period, vital signs data, degree of satisfaction from surgeons and patients were recorded. RESULTS The arousal time was （11.5 ＋ 3.7） min. The quality of awakening in wake-up period （first-class plus second-class） was 93.3 %. The average incidence of adverse events in wake-up period was 6.67 %. The degree of satisfaction of surgeons was （96.8 ＋ 4.6） and that of patients was （90.4 ＋ 5.9）. CONCLUSION Dexmedetomidine could be safely and effec tively used for conscious sedation in awake craniotomy. It has advantages of shorter arousal time, better quality of awaken ing, lower average incidence of adverse events and higher degree of satisfaction of surgeons and patients.

关 键 词：右美托咪啶 唤醒麻醉 清醒开颅术 

分 类 号：R614[医药卫生—麻醉学]