右美托咪定联合瑞芬太尼中度镇静镇痛用于头面部手术的临床评价  

Dexmedetomidine combined with remifentanil for moderate sedation and analgesia in facial plastic surgery

作　　者：王玉慧 薛富善 金锦花 温超 王磊 邓晓明 WANG Yuhui;XUE Fushan;JIN Jinhua;WEN Chao;WANG Lei;DENG Xiaoming(Department of Anesthesiology,Plastic Surgery Hospital,Chinese Academy of Medical Sciencesand Peking Union Medical College,Beijing 100144,China;Department of Anesthesiology,Beijing Friendship Hospital of Capital Medical University,Beijing 100050,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144 [2]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《中华实用诊断与治疗杂志》2020年第10期1061-1064,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：中国医学科学院整形外科医院院所基金(C2017002);中国医师协会麻醉学医师分会青年麻醉医师科研基金(21800010)。

摘　　要：目的探讨头面部手术中应用右美托咪定联合瑞芬太尼维持中度镇静镇痛的有效性和安全性,比较手控输注与靶控输注瑞芬太尼的效果。方法 60例ASA分级Ⅰ或Ⅱ级的择期头面部整形手术患者,随机分为靶控输注瑞芬太尼组(靶控组)30例和手控输注瑞芬太尼组(手控组)30例。2组右美托咪定均为负荷剂量1μg/kg,维持剂量0.2~1.0μg/(kg·h);靶控组瑞芬太尼初始靶浓度2.5μg/L,术中根据呼吸抑制情况和疼痛反应每次递减或递增靶浓度0.3μg/L;手控组瑞芬太尼负荷剂量0.5μg/kg,维持剂量0.1μg/(kg·min),调整梯度为0.02μg/(kg·min);术中调整输注速度或靶浓度以维持中度镇静水平(改良警觉/镇静评分4~3分)。比较2组术中中度镇静成功率、患者满意度等有效性指标,低氧血症、呼吸抑制情况等安全性指标,术中疼痛、咪达唑仑补救和术中记忆等发生情况。结果靶控组术中中度镇痛成功率(86.7%)和低氧血症发生率(20.0%)与手控组(73.3%、26.7%)比较差异无统计学意义(P>0.05);靶控组呼吸过缓和/或呼吸暂停发生率(23.3%)低于手控组(50.0%)(P<0.05),术中疼痛反应(30.0%)、咪达唑仑补救(36.7%)、术中记忆(43.3%)、术后恶心呕吐(16.7%)发生率及术后患者满意度(100.0%)与手控组(26.7%、30.0%、40.0%、23.3%、96.7%)比较差异无统计学意义(P>0.05)。结论右美托咪定联合瑞芬太尼中度镇静镇痛可满足头面部手术要求,镇静深度可控性强;靶控输注瑞芬太尼对呼吸频率影响小,低氧血症发生率与手控输注无明显差异。Objective To evaluate the safety and efficacy of dexmedetomidine combined with remifentanil on maintaining moderate sedation and analgesia in facial plastic surgery, and compare the efficacy of manually controlled and target-controlled infusion of remifentanil. Methods Sixty ASA grade Ⅰ or Ⅱ patients undergoing elective facial plastic surgery were enrolled and randomly divided into target-controlled infusion group(n=30) and manually controlled infusion group(n=30). The loading dose of dexmedetomidine was 1 μg/kg and the maintenance dose was 0.2 to 1.0 μg/(kg·h) in both groups. Target-controlled infusion group received remifentanil at initial target concentration of 2.5 μg/L, followed by 0.3 μg/L adjustment each time according to respiratory depression and pain response, and manually controlled infusion group received remifentanil in a loading dose of 0.5 μg/kg followed by a maintenance dose of 0.1 μg/(kg·min) with 0.02 μg/(kg·min) adjustment. The infusion or target concentration was adjusted to maintain moderate sedation level(score of 3-4 on the Modified Observer’s Assessment of Alertness/Sedation scale). The achieved moderate sedation rate, satisfaction scores, incidence of hypoxemia, respiratory depression, as well as intraoperative pain, midazolam rescue and recall were compared between two groups. Results The achieved moderate sedation rate and incidence of hypoxemia showed no significant differences between target-controlled infusion group(86.7%, 20.0%) and manually controlled infusion group(73.3%, 26.7%)(P>0.05). The incidence of bradypnea and/or apnea was lower in target-controlled infusion group(23.3%) than that in manually controlled infusion group(50.0%)(P<0.05). There were no significant differences in intraopeative perception of pain(30.0% vs. 26.7%), midazolam rescue(36.7% vs. 30.0%), recall (43.3% vs.40.0%),incidence of postoperative nausea/vomiting(16.7% vs.23.3%),and satisfaction score(100.0%vs.96.7%)(P>0.05).Conclusion Dexmedetomidine combined with remifentanil may provide suffic

关 键 词：右美托咪定 阿片类 清醒镇静 镇痛 

分 类 号：R614[医药卫生—麻醉学]