咪达唑仑和地佐辛分别联合瑞芬太尼在肝癌射频消融术中的应用  

Application of Midazolam or Dezocine combined with Remifentanil in RFA of hepatocellular carcinoma

作　　者：刘宝伟[1] 闫俊莲 张加强[1] LIU Bao-wei;YAN Jun-lian;ZHANG Jia-qiang(Department of Anesthesia and Perioperative Medicine,Henan Provincial People's Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科,郑州450000

出　　处：《医药论坛杂志》2023年第12期102-106,共5页Journal of Medical Forum

摘　　要：目的探究咪达唑仑和地佐辛分别联合瑞芬太尼在肝癌射频消融术(radio frequency ablation,RFA)中的应用效果。方法选择2020年12月—2022年12月于河南省人民医院接受RFA治疗的肝癌患者60例,随机分组为咪达唑仑组和地佐辛组,每组30例。咪达唑仑组予0.05~0.10 mg/kg咪达唑仑静注,地佐辛组予0.8 mg/kg地佐辛静注,两组用药后5 min均予瑞芬太尼0.2μg/kg静注,RFA开始时泵注0.05μg/(kg·min)瑞芬太尼至术毕。监测并比较两组在麻醉诱导前至苏醒即刻内5个时刻的心率、平均动脉压、血氧饱和度变化情况;评估并比较两组苏醒即刻和1、2、3 h的疼痛情况[视觉模拟评分法(VAS)];检测并比较两组RFA术前及术后1天的白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)血清浓度水平;统计并比较两组麻醉相关不良反应。结果两组患者麻醉诱导前至苏醒即刻内5个时刻的心率、平均动脉压、血氧饱和度水平比较,差异无统计学意义(P>0.05);地佐辛组术后1、2、3 h的VAS评分均低于咪达唑仑组,差异有统计学意义(P<0.05);地佐辛组术后1 d的IL-6、TNF-α水平低于咪达唑仑组,差异有统计学意义(P<0.05)。咪达唑仑组中出现呼吸抑制3例,地佐辛组中无呼吸抑制情况,但两组患者麻醉相关不良反应比较,差异无统计学意义(P>0.05)。结论肝癌RFA麻醉中,地佐辛联合瑞芬太尼方案相较于咪达唑仑联合瑞芬太尼方案的镇痛效果更好,还可减轻患者术后炎症反应,安全性好。Objective To explore the application effects of midazolam or dezocine combined with remifentanil in the radiofrequency ablation(RFA) of hepatocellular carcinoma(HCC).Methods Sixty patients with HCC who were treated with RFA in the hospital from December 2020 to December 2022 were selected and randomly divided into midazolam group and dezocine group,with 30 cases in each group.The midazolam group was given 0.05-0.10 mg/kg of midazolam intravenously,and the dezocine group was intravenously given 0.8 mg/kg of dezocine.0.2 μg/kg of remifentanil was intravenously injected at 5 min after medication in both groups,and 0.05 μg/(kg·min) of remifentanil was pumped at the beginning of RFA until the end of surgery.Heart rate,mean arterial pressure and blood oxygen saturation were monitored and compared between the two groups at five time points during the period from before anesthesia induction to immediately after awakening.Pain status [Visual Analogue Scale(VAS)] was evaluated and compared immediately after awakening and at 1,2 and 3 h after awakening.The levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) before RFA and at 1 d after RFA were detected and compared between the two groups.The anesthesia-related adverse reactions in the two groups were counted and compared.Results There were no statistical differences in heart rate,mean arterial pressure and blood oxygen saturation between the two groups of patients at five time points during the period from before anesthesia induction to immediately after awakening(P>0.05).The VAS scores at 1,2 and 3 h after surgery in dezocine group were lower than those in midazolam group(P<0.05).The levels of IL-6 and TNF-α in dezocine group were lower than those in midazolam group at 1 d after surgery(P<0.05).There were 3 cases of respiratory depression in midazolam group and no respiratory depression in dezocine group,but there were no statistically significant differences in anesthesia-related adverse reactions between both groups(P>0.05).Conclusion Compared with mid

关 键 词：咪达唑仑 地佐辛 瑞芬太尼 肝癌 射频消融术 应用效果 

分 类 号：R735.7[医药卫生—肿瘤]