右旋美托咪啶复合瑞芬太尼用于甲亢患者手术麻醉

Effect of Dexmedetomidine Combined Remifentanil on Anesthesia of Patients Underwent Hyperthyreosis Surgery

目的:探讨右旋美托咪啶(Dex)复合瑞芬太尼用于颈部硬膜外阻滞甲亢手术的可行性。方法:将60例择期行甲状腺大部切除术患者随机分为对照组(F组)、瑞芬太尼组(R组)和右旋美托咪啶复合瑞芬太尼组(D组),均先行颈部硬膜外阻滞麻醉。手术开始时,F组静脉缓注咪唑安定0.5 mg/kg+芬太尼0.1 mg;R组静脉缓注咪唑安定0.5 mg/kg+瑞芬太尼0.12～0.05μg/(kg.min)-1;D组先静脉缓注右旋美托咪啶0.5μg/kg,然后同时持续输注右旋美托咪啶0.2μg/(kg.h)-1+瑞芬太尼0.05μg/(kg.min)-1,术后止血结束即停止输注。记录3组在手术前(T0)、手术开始后5 min(T1)、游离甲状腺上下极时(T2)和术毕(T3)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、视觉模拟评分(VAS评分)和Ramsay镇静评分。结果:在手术刺激最强的T2时间点,R组和D组VAS评分及MAP、HR均明显低于F组(P<0.01,P<0.05),Ramsay镇静评分明显高于F组(P<0.05),但R组、D组间比较差异无显著性(P>0.05)。结论:右旋美托咪啶复合瑞芬太尼用于颈部硬膜外阻滞行甲亢手术可取得良好的镇痛镇静效果,既维持了呼吸、循环稳定,又减少了手术并发症发生。

Objective To investigate the feasibility and safety of dexmedetomidine combined with remifentanil using in the trachel-epidural anesthesia in patients underwent hyperthyreosis srugery.Methods Sixty patients of primary hyperthyroidism with subtotal thyroidectomy were randomly divided into three groups:control group(group F),remifentanil group(group R) and dexmedetomidine combined remifentanil group(group D).All patients were suffered from trachel-epidural anesthesia.At the onset of operation,midazolam(0.5 mg/kg) and fentanyl(0.1 mg) were intravenous injected in group F,midazolam(0.5 mg/kg) and remifentanil [0.12~0.05 μg/(kg·min)-1] were given in group R,dexmedetomidine(0.5 μg/kg) were pretreated in 10 minutes and dexmedetomidine[0.2 μg/(kg·h)-1]and remifentanil [0.05 μg/(kg·min)-1] were given in group D.The drugs withdrawal were performed after hematischesis.MAP,HR,SpO2,VAS,Ramsay score at pre-operation(T0),5 min post-operation(T1),dissociation of thyroid(T2),after operation(T3) were recorded,respectively.Results At T2,the VAS,MAP and HR in group R and group D were obviously decreased than those of group F(P<0.01),the Ramsay scores were significantly increased(P<0.05).There were no significant difference between group R and group D(P>0.05).Conclusion Dexmedetomidine combined with remifentanil showed satisfactory sedative and analgesia effects in the trachel-epidural anesthesia of hyperthyreosis surgery,which could sustain the stability of patient's repiratory and circulation,and reduce the incidence of complication.