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小剂量右美托咪定用于局麻下玻璃体切割术的镇静效果观察
引用本文:张芳芳,张英茹,马鸿雁,闫全章,常雪南.小剂量右美托咪定用于局麻下玻璃体切割术的镇静效果观察[J].生物磁学,2014(6):1117-1120,1127.
作者姓名:张芳芳  张英茹  马鸿雁  闫全章  常雪南
作者单位:哈尔滨医科大学附属第一医院,黑龙江哈尔滨150001
摘    要:目的:探讨右美托咪定用于局麻下玻璃体切割术的镇静效果。方法:选择拟在局麻监测下行玻璃体切割术患者50 例为研究对象,年龄20-72岁,ASA 分级Ⅱ级~Ⅲ级,随机分为右美托咪定组(D组)和咪达唑仑组(M 组),每组25 例。D组患者于术前10min 静脉泵注右美托咪定0.5 滋g/kg,后以0.2-0.4 μg/kg.h 的速度持续输注,M组术前10 min 缓慢静脉注射咪达唑仑0.02 mg/kg,术中按需静注0.5 mg/ 次。维持VAS 评分≤ 4 分,Ramsay评分2-4 分。记录和比较两组患者术中血压、心率、呼吸的变化、辅助用药及患者对镇静效果的满意度。结果:给药后,M组T5时点MAP较T0显著下降(P〈0.05),D组T10及以后各时点MAP 较T0显著下降(P〈0.05);D 组T5及以后各时点BP 较T0显著下降(P〈0.05),但组间及M 组组内BP 比较差异无统计学意义(P〉0.05);M 组T30时点HR 较T0 显著下降(P〈0.01),而在T5时,组间比较差异有统计学意义(P〈0.01),即D 组下降更为显著。给药后各时点,D 组VAS 评分均显著低于M组(P〈0.05),30 min 时达最低。两组Ramsay镇静评分给药后5 min 均达2 级以上,与给药前比较均显著升高(P〈0.05),D组给药后30 min 及以后各时点Ramsay镇静评分均显著高于M组(P〈0.01)。给药后各时点,两组组内和组间SPO2和RR 比较均无统计学差异(P〉0.05)。D 组患者满意度较M组更高(P〈0.05)。结论:小剂量右美托咪定用于玻璃体切割术可使患者血流动力学平稳,镇静效果良好,疼痛感觉减轻,舒适度提高。

关 键 词:右关托咪定  咪达唑仑  局部麻醉  玻璃体切割术

Observation on the Sedative Effect of Low-dosage Dexmedetomidine in the Treatment of Vitrectomy Underlocal Anesthesia
ZHANG Fang-fang,ZHANG Ying-ru,MA Hong-yan,YAN Quan-zhang,CHANG Xue-nan.Observation on the Sedative Effect of Low-dosage Dexmedetomidine in the Treatment of Vitrectomy Underlocal Anesthesia[J].Biomagnetism,2014(6):1117-1120,1127.
Authors:ZHANG Fang-fang  ZHANG Ying-ru  MA Hong-yan  YAN Quan-zhang  CHANG Xue-nan
Institution:(The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongiiang, 150001, China)
Abstract:Objective: To investigate the Sedative effect of low-dosage dexmedetomidine and midazolam on patients who would undergo vitrectomy under local anesthesia. Methods: Fifty ASA I - II patients, aged 20-72 yr, undergoing elective vitrectomy under local anesthesia were randomly divided into 2 groups n=25,the dexmedetomidine group and midazolam group. Before operation, patients either infused dexmedetomidine 0.5 μg/kg in 10 min, followed by 0.2-0.4 μg/kg.h, or midazolam 0.02 mg/kg i.v.followed by 0.5 mg i.v. as required. Sedation was titrated to a Ramsay sedation score of 2-4.Blood pressure, heart rate, respiratory rate,dose of adjuvant drugs and patients'satisfaction were recorded. Results: After infusion, MAP of group M significantly decreased at T5 compared with To, so did group D at T~0 and each time after T~0. BP of group D significantly decreased at T5 and each time after T5 compared with To, but there was no significant difference between two groups and in group M; HR of group M significantly decreased compared with To, and at T5, there was statistical difference between groups. The points after infusion, VAS score of group D were significantly lower than that of group M, 30 min to the minimum. Ramsay sedation score of the two groups increased to grade 2 at 5 min after infusion, and significantly increased after infusion in group D, which was significantly higher than group M at 30 min and later. There was no difference of SPO2 and RR be- tween groups and in each group. Patient satisfaction of group D was higher than that of group M (P〈0.05). Conclusion: Low-dosage dexmedetomidine as a sedative on patients who would undergo vitrectomy under local anesthesia can improve hemodynamic stabiliza- tion, decrease patients' pain perception and increase comfort.
Keywords:Dexmedetomidine  Mdazolam  Local anesthesia  Vitrectomy
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