咪达唑仑-瑞芬太尼清醒镇静镇痛用于高强度聚焦超声治疗的可行性研究

Application of Midazolam-remifentanil Conscious-sedation and Analgesia in High Intensity Focus Ultrasound Treatment

目的观察和探讨咪达唑仑-瑞芬太尼清醒镇静镇痛用于高强度聚焦超声(HIFU)治疗的有效性、安全性和可行性。方法选择行肝脏、胰腺、乳腺肿瘤和子宫肌瘤HIFU治疗的患者各20例,分为4组。给予咪达唑仑0.02 mg·kg-1和瑞芬太尼1μg.kg-1负荷,再分别以0.05 mg·kg-·1h-1和0.05μg·kg-·1min-1持续泵注,调整速度/3min,Ramsy评级3～4级和疼痛评分≤4分时开始HIFU治疗。记录麻醉前(T0)、麻醉开始3 min(T1)、5 min(T2)、10 min(T3)、治疗开始(T4)、治疗中(T5,30 min记录1次,取均值)、治疗结束后5 min(T6)、10 min(T7)时的收缩压(SP)、舒张压(DP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)、脑电双频指数(BIS)、药物泵注速度和不良反应,治疗结束后行患者满意度评分和术者满意度评分。结果各组SP、DP在麻醉后显著降低,治疗中显著升高(P<0.05),麻醉结束后恢复;HR也表现类似的变化。麻醉后RR显著降低(P<0.05),但SpO2值均>93.9%,麻醉结束后迅速恢复;麻醉中BIS波动于88.7～90.3之间,麻醉结束后恢复至基础值;Ramsy评级为3.95～4.15级,疼痛评分为0～1分;患者满意度评分和术者满意度评分均>3分。乳腺组的药物泵注速度显著高于其他3组(P<0.05)。各组均未发生麻醉不良反应和并发症。结论咪达唑仑-瑞芬太尼清醒镇静镇痛用于HIFU治疗肝脏、胰腺、乳腺肿瘤和子宫肌瘤时麻醉效果良好,是一种安全、有效、可行的麻醉方法。

Objective To observe the efficacy,safety and feasibility of midazolam-remifentanil conscious-sedation and analgesia in the High Intensity Focus Ultrasound（HIFU）treatment.Methods Patients with hepatic tumor,pancreatic tumor,hysteromyoma or breast tumor,treated by HIFU,were included and allocated into 4 groups,20 cases in each group.A bolus of midazolam 0.02 mg.kg-1 and remifentanil 1 μg.kg-1 was applied as loading dose,followed by infusion of midazolam 0.05 mg.kg-1.h-1 and remifentanil 0.05 μg.kg-1.min-1.The dosage was adjusted in 3 min interval according to the Ramsy rank and Verbal Rating Scale. The SP, DP, HR, RR, SpO= and BIS were recorded in the following periods, pre-anesthesia （T0）, 3 min （ T1 ）, 5 rain （ T2 ）, 10 min （ T3 ）, start of operation （ T4 ）, duration of operation （ T5 ）, post-operation 5 min （T6）,and 10 rain （T7）. The dosage and adverse effects of drugs were also recorded. Satisfaction Rank of Patient and Satisfaction Rank of Operator were collected after the procedures. Results The SP and DP of the patients in all groups were decreased compared with the base line values after the induction of the anesthesia （P 〈 0.05）,and elevated during the operating procedure compared with the base line values and those in the post-operation period（P 〈 0.05）. The tendency of HR was similar to SP and DP. RR of the patients in all groups reduced compared with the baseline values （P 〈 0.05 ）.However,the lowest level of SpO2 was 93.9%,and both of them returned to base line value. The BIS value ranged 88.7-90.3 during the procedure and retttmed to baseline. The average of Ramsy Rank was 3.95- 4.15,and the average of VRS score was 0-1. Both of the Satisfaction Rank of Patient and Satisfaction Rank of Operator were greater than 3 point. The dosage of drug consumed in breast tumor group was greater than those in other groups（P 〈 0.05 ）. No adverse effects and compli- cations associated with anesthesia occurred in any patient. Conclusion Midazolam-remifentanil conscious-sedation and analgesia was an ef- fective and safe measure for the HIFU procedure to treat the liver tumor, pancreatic tumor,hysteromyoma or breast tumor.