摘要
目的 评价右美托咪定在全身麻醉下胰腺癌高强度聚焦超声（HIFU）治疗中的作用.方法 选择择期胰腺癌HIFU治疗患者120例,ASA分级Ⅱ～Ⅲ级,将患者按随机数字表法分为对照组（C组）和右美托咪定组（D组）,每组60例.D组麻醉诱导前15 min经静脉输注右美托咪定负荷量0.7μg/kg,随后以0.2μg/（kg·h）的速率静脉输注至术毕,C组给予等容量0.9％氯化钠.两组负荷量输注完毕后5 min均静脉注射芬太尼2～3μg/kg、丙泊酚1.5～ 2.0 mg/kg和顺阿曲库铵0.2 mg/kg麻醉诱导,麻醉维持采用七氟烷、雷米芬太尼、丙泊酚、顺阿曲库铵.记录两组丙泊酚、雷米芬太尼和七氟烷用量,术后躁动、谵妄、苏醒延迟的发生情况.结果 D组术中心率均低于C组,差异有统计学意义（P＜0.05）.D组丙泊酚、雷米芬太尼和七氟烷用量均少于C组[（341.4±45.7） mg比（520.5±50.8）mg、（1.7±0.5） mg比（2.3±0.8）mg、（11.6±4.1） ml比（16.7±3.8） ml],差异有统计学意义（P＜0.05）.D组术后躁动和谵妄发生率低于C组[6.7％（4/60）比21.7％（13/60）和8.3％（5/60）比26.7％（16/60）],差异有统计学意义（P＜0.05）；D组和C组术后苏醒延迟发生率比较差异无统计学意义[3.3％（2/60）比1.7％（1/60）,P＞0.05].结论 右美托咪定可减少胰腺癌HIFU治疗患者全身麻醉药用量,降低术后躁动和谵妄发生率,降低术中心率.
Objective To investigate the effect of dexmedetomidine on patients with pancreatic cancer treated by high intensity focused ultrasound （HIFU） under general anesthesia.Methods One hundred and twenty ASA Ⅱ or Ⅲ patients with pancreatic cancer undergoing HIFU treatment,were divided into control group （group C） and dexmedetomidine group （group D） by random digits table method,each group with 60 cases.Dexmedetomidine was intravenously infused at 0.2 μ g/（kg· h） until the end of operation after a loading dose of 0.7 μg/kg over 15 min before induction of anesthesia in group D,while the equal volume of normal saline was infused in group C.Anesthesia was induced with intravenous injection of fentanyl 2-3 μg/kg and propofol 1.5-2.0 mg/kg and cisatracurium 0.2 mg/kg at 5 min after administration of the loading dose.Anesthesia was maintained with sevoflurane,remifentanil,propofol,cisatracurium.The propofol,remifentanil and sevoflurane consumption,the incidence of postoperative agitation,delirium,delayed recovery were recorded.Results The intraoperative heart rate in group D was significantly lower than that in group C （P 〈 0.05）.The propofol,remifentanil and sevoflurane consumption in group D were significantly shorter than those in group C [（341.4 ± 45.7） mg vs.（520.5 ± 50.8） mg,（1.7 ± 0.5） mg vs.（2.3 ± 0.8） mg,（11.6 ± 4.1） ml vs.（16.7 ± 3.8） ml,P 〈 0.05].The incidence of postoperative agitation and delirium in group D were significantly lower than those in group C [6.7%（4/60） vs.21.7%（13/60）,8.3% （5/60） vs.26.7% （16/60）,P 〈 0.05].There was no statistically significant difference in the incidence of delayed recovery between group D and group C [3.3% （2/60） vs.1.7% （1/60）,P 〉 0.05].Conclusions Dexmedetomidine given HIFU treatment of pancreatic cancer patients can reduce the amount of general anesthetic,reduce the incidence of postoperative agitation and delirium,intraoperative heart rate.
出处
《中国医师进修杂志》
2013年第21期5-8,共4页
Chinese Journal of Postgraduates of Medicine
关键词
右美托咪啶
麻醉
高强度聚焦超声消融
胰腺肿瘤
Dexmedetomidine
Anesthesia
High-intensity focused ultrasound ablation
Pancreatic neoplasms
