右旋美托咪啶对局部麻醉下甲状腺手术患者血流动力学和呼吸的影响  

Effects of dexmedetomidine on circulation and respiration in thyroidectomy under local anesthesia

作　　者：刘宇飞[1] 石景辉[1] 孙波[1] 郭力甲[1] 李恩有[1] 

机构地区：[1]哈尔滨医科大学附属第一医院麻醉科,黑龙江哈尔滨150001

出　　处：《哈尔滨医科大学学报》2014年第3期218-222,共5页Journal of Harbin Medical University

摘　　要：目的了解右旋美托咪啶辅助局部麻醉下甲状腺手术镇静镇痛效果和对循环、呼吸的影响。方法拟将50例ASAⅠ-Ⅱ级患者在局部麻醉下行甲状腺大部切除手术，随机分为两组：实验组（D组）与对照组（C组），每组25例。D组于局麻前10min开始泵注右旋美托咪啶每小时6μg·kg^-1持续10min，之后以每小时0．2μg·kg^-1维持；C组于局麻前10min开始静脉注射氟哌利多0．05mg·kg^-1。两组患者均在术前5min给予静脉注射芬太尼1μg·kg^-1，手术至剥离腺体前2min加用芬太尼0．5μg·kg^-1静注。分别于入室后（T0）、切皮前（T1）、切皮时（T2）、术中分离颈前筋膜时（T1）、处理腺体时（T4）、缝皮时（T5）和手术结束时（T6），观察并记录两组患者的平均动脉压（MAP），心率（HR），心电图（ECG），脉搏氧饱和度（SpO2），呼吸频率（RR），OAA／S镇静评分，VAS镇痛评分，术中配合评分及术中应用芬太尼的次数。结果D组患者的MAP和HR自切皮前至缝皮时均低于C组（P〈0．05）；两组患者的ECG均未见明显异常。两组患者各时刻的SpO2无显著性差异（P〉0．05）；D组患者术中切皮前、切皮时和分离颈前筋膜时的RR均低于C组（P〈0．05）。D组OAA／S镇静评分自切皮前至缝皮时均显著低于C组（P〈0．01）。两组患者各时刻的VAS评分无显著性差异（P〉0．05）。D组患者的配合程度显著好于C组（P〈0．01）。D组患者术中应用芬太尼的次数显著少于C组（P〈0．01）。结论泵注右旋美托咪啶用于局部麻醉下甲状腺手术可有效抑制患者心血管反应，无明显呼吸抑制，具有良好镇静、镇痛、辅助局麻的效果。Objective To study the analgesic and sedative efficacy of dexmedetomidine and to observe its effect on circulation and respiration in thyroidectomy during local anesthesia. Methods Fifty patients of ASA grade Ⅰ or Ⅱ scheduled for thyroidectomy under local anesthesia were randomly divided into experiment group （ D, n = 25 ） and control group （ C, n = 25 ）. Group D was administered dexmedetomidine at 6μg·kg^-1· h^-1 by microinfusion 10 min before local anesthesia followed by an infusion rate of 0. 2μg·kg^-1· h^-1. Group C was administered droperidol 10 rain before local anesthesia. Fentanyl 1 μg·kg^-1 was given to all patients 5 min before operation and fentanyl 0. 5 μg·kg^-1 was given to all patients 2 min before treated glandular organ. MAP, HR, ECG, SpO2, RR, OAA/S, VAS, cooperation score and frequency of fentanyl were observed and recorded when getting room （ T0 ）, before cut skin （ T1 ）, after cut skin （T2）, separate anadesma ante-neck （T3 ）, treated glandular organ （ T4 ）, suture skin （T5） and termination of operation （ T6 ）. Results The MAP and HR of group D were lower than group C since T1 to T5 （ P 〈 0. 05 ）. There was no difference on ECG and SpO2 between the two groups （P 〉 0.05 ）. The RR of group D were lower than group C since T1 to T3 （ P 〈 0. 05）. OAA/S of group D was significantly lower than group C since T1 to T5 （ P 〈 0. 01 ）. There was no difference on VAS score between the two groups （P 〉 0. 05 ）. Cooperation score of group D was more content than group C （P.〈 0. 01 ）. The frequency of fentanyl of group D were significantly lower than group C （P 〈 0. 01 ）. Conclusion Microinfusion dexmedetomidine can efficiently inhibit cardiovascular effects and shows no respiratory depression in thyroid- ectdmy under local anesthesia, also can provide satisfactory effects on analgesia and sedation and assistant anesthesia.

关 键 词：右旋美托咪啶 局部麻醉 甲状腺手术 镇静 镇痛 

分 类 号：R614.3[医药卫生—麻醉学]