地佐辛和右旋美托咪定联合用药在青少年斜视矫正术中的应用  

Application of dezoxine plus dexmedetomidine in strabismus surgery

作　　者：叶伟娣[1] 胡智勇[3] 孙朝晖[2] 

机构地区：[1]浙江大学医学院附属第二医院麻醉科,杭州310009 [2]浙江大学医学院附属第二医院眼科,杭州310009 [3]浙江大学医学院附属儿童医院麻醉科

出　　处：《中华医学杂志》2014年第19期1479-1482,共4页National Medical Journal of China

基　　金：浙江卫生厅重点项目（2013ZDA011）

摘　　要：目的 观察地佐辛和右旋美托咪定联合用药在青少年水平共同性斜视矫正术镇痛镇静效果及不良反应.方法 选择浙江大学医学院附属第二医院眼科2013年9-12月择期行单纯水平共同性斜视矫正术,10～16岁病例共60例,数字表法随机分为两组,每组30例.用药组：在术前15 min静脉注射地佐辛0.1 mg/kg,同时静脉输注右旋美托咪定0.4 μg· kg^-1 ·h^-1至第一条眼肌手术结束;对照组：在术前15 min静脉注射和输注等量生理盐水.观察两组患者的视觉模拟评分（VAS）,镇静评分（Ramsay）、焦虑评分（SAS）、平均动脉压（MAP）、心率、手术时间、头晕、呕吐、皮肤瘙痒、呼吸抑制、牵拉不适情况.结果 VAS评分：与对照组相比,用药组从牵拉第一条眼肌（T2）到术后2 h（T5）[（1.8 ±l.3）比（2.8±1.6）,（1.2±0.9）比（2.1±1.3）,（0.6±0.5）比（1.9±2.2）,（0.9±0.8）比（2.3±1.4）]各时间点明显降低（均P＜0.05）.Ramsay评分：对照组T2致牵拉第二条眼肌（T3） Ramsay评分为1分,用药组可达2～3分（均P＜0.05）.SAS评分：用药组术前（35.0±6.0）与术后（24.0±4.0）评分差异有统计学意义（P＜0.05）,用药组手术时间较对照组短（P＜0.05）.对照组较用药组牵拉眼肌时（T2、T3）牵拉反射时心率更低（P＜0.05）,差异具有统计学意义.牵拉不适情况对照组25例,而用药组仅5例.结论 地佐辛和右旋美托咪定复合用药可以很好的满足眼科斜视矫正手术的需要,与单纯局麻相比,患者的疼痛和焦虑明显改善,具有一定的镇静作用,能够很好的配合眼科医生操作.是一个安全可靠,值得推广的方法.Objective To observe the effects of intra-operative combined dosing of dezoxine and dexmedetomidine on sedation,analgesia and the incidence of untoward events during and after surgery in teenagers undergoing horizontal concomitant strabismus surgery.Methods For this prospective and randomized trial,approval was obtained from the Ethical Committee and informed consent from their parents.A total of 60 patients aged 10-16 years undergoing strabismus surgery at Second Affiliated Hospital from September to December 2013 were collected.The treatment group received an intravenous dose of dezoxine 0.1 mg · kg^-1 at 15 minutes before surgery.And another intravenous injection of dexmedetomidine was administered at 0.4 μg · kg^-1 · h^-1 until the end of the first ocular muscle correcting.The control group received the same volume of normal saline.Observational parameters including visual analogue scale （VAS）,Ramsay scores,self-rating anxiety scale （SAS）,heart rate （HR）,blood pressure and the incidence of untoward events such as nausea and vomiting or arrhythmia were recorded.Results The VAS pain scores in the treatment group at T2-T5 decreased significantly versus the control group （P 〈 0.05）The Ramsay scores in the treatment group at T2-T3 increased and significantly differences existed with the control group （P 〈 0.05）.SAS scores showed significant differences between pre-operative and postoperative periods in the treatment group （P 〈 0.05）.The treatment group has shorter operative duration with 5 cases of dragging pain in the treatment group versus 25 in the control group （P 〈 0.05）.During dragging reflex,HR was lower in the control group at T2 and T3.There were significant differences with the control group （P 〈 0.05）.Conclusion A combination of dezoxine and dexmedetomidine provide multiple benefits for patients undergoing strabismus surgery.Compared with simple local anesthesia,it effectively attenuates pain and anxiety and provides mild sedation and better cooperation duri

关 键 词：地佐辛 右旋美托咪定 斜视矫正术 

分 类 号：R777.41[医药卫生—眼科]