右美托咪定在喉显微镜手术中的临床应用研究  

作　　者：侯俊芳[1] 

机构地区：[1]江西省人民医院麻醉科,江西330006

出　　处：《当代医学》2015年第4期153-155,共3页Contemporary Medicine

摘　　要：目的探究右美托咪定在喉显微镜手术中的临床应用价值。方法选取进行喉显微外科手术的患者42例,采用随机数字表均分为实验组A 1组、A 2组和对照组B组(n=14)。所有患者在术前常规使用0.5 mg盐酸戊乙奎醚以及10 mg苯巴比妥钠;根据右美托咪定药物动力学效应,于术前15 min对A 1组静脉注射右美托咪定0.5μg/kg,对于A 2组注射右美托咪定1.0μg/kg,对于B组注射等量生理盐水15 m L,注射时间为10 min。麻醉诱导:于术前5 min依次静脉注入0.04 mg/kg咪达唑仑,4μg/kg芬太尼,0.11 mg/kg维库溴铵,2.5 mg/kg丙泊酚。在手术过程中对患者持续注入丙泊酚5 mg/(kg·h)维持镇静,直至手术结束。观察患者进入手术室尚未使用任何麻醉药物时(T1)、手术开始时(T2)、手术结束时(T3)时的心率、镇静程度(Ramsay)评分及平均动脉压。结果 (1)在手术中镇静程度的比较,A 1、A 2组明显高于对照组,差异有统计学意义(P<0.05);而A 2组T2、T3时的镇静程度[(4.88±0.43)分、(4.08±0.56分)]又明显高于A 1组[(4.26±0.46分)、(3.97±0.44分)],差异有统计学意义(P<0.05);(2)手术中患者的心率比较,A 1、A 2组T2、T3时明显低于对照组[(83.9±5.2)次/min、(90.2±5.2)次/min)],差异有统计学意义(P<0.05);其中A 2组[(64.5±4.8)次/min、(68.5±4.8)次/min)]又略低于A 1组[(67.7±5.4)次/min、(69.7±4.4)次/min],差异有统计学意义(P<0.05);(3)术中患者的平均动脉压比较,实验组A 1、A 2显著低于对照组,差异有统计学意义(P<0.05);其中A 2组[(72.5±7.5)mm Hg、(80.2±8.7)mm Hg]平均动脉压低A 1组[(74.5±8.1)mm Hg、(81.5±7.9)mm Hg],差异有统计学意义(P<0.05)。结论右美托咪定能够明显提高术中镇静效果,在安全范围内减慢心率,降低血压,使患者的身体状态达到喉显微外科手术的最适麻醉水平,加大喉显微外科手术安全性,对临床具有指导意义。Objective To explore the clinical application value of dexmedetomidine in laryngeal surgery microscope. Methods 42 patients with laryngeal microsurgery surgery were selected and divided into the experimental group A 1, A 2 and the control group B（n=14） by using random number table. In the preoperative period, all patients took 0.5 mg penehyclidine hydrochloride and 10 mg phenobarbital sodium routinely. According pharmacokinetics effect of dexmedetomidine, 15 min before operation, group A 1 was given intravenous injection of dexmedetomidine （0.5 μg/ kg）, group A 2 was given injection of dexmedetomidine （1.0 μg/kg）, and group B was given injection of saline （15 mL） for 10 minutes. Anesthesia induction： 5 minutes before operation, all patients were given intravenous injection of midazolam （0.04 mg/kg）, fentanyl （4 μg/kg）, vecuronium bromide （0.11 mg/kg）, propofol （2.5 mg/kg）. During surgery, patients were given continuous injection of propofol 5 mg/（kg· h） to remain calmuntil the end of surgery. Heart rate, sedation score （Ramsay）, and mean arterial pressure when patients into the operating room had not used any anesthetic （T1）, surgery at the beginning （T2）, at the end of surgery （T3） were observed. Results （1） Sedation score of group A1 and A 2 are higher than that of control group, the difference was statistically significant （P〈0.05）; Sedation score of group A2 [（4.88±0.43）, （4.08±0.56）] group at T2 and T3 was higher than the A1 [（4.26±0.46）, （3.97±0.44）], the difference was statistically significant （P〈0.05）; （2） At T2 and T3, heart rate of group A 1, A 2 were lower than that of control group [（83.9±5.2）, （83.9 ± 5.2）], the differences was statistically significant （P〈0.05）; heart rate of group A 2 [（64.5± 4.8）, （68.5 ±4.8）] was slightly lower than group A 1 [（67.7±5.4）, （67.7±4.4）], the difference was statistically significant（P〈0.05）; （3） Mean arterial pressure of gro

关 键 词：右美托咪定 喉显微外科手术 镇静分数 

分 类 号：R614[医药卫生—麻醉学]