右美托咪啶在乳腺局部活检手术中镇静效果评价

Effects of dexmedetomidine for sedation of patients undergoing breast local biopsy requiring MAC

目的评价右美托咪啶(dexmedetomidine,DEX)作为基础镇静用药在麻醉管理监护(monitored anesthesia care,MAC)下行乳腺局部活检手术的安全性及有效性。方法 90例患者采用Excel表产生的组间样本量平衡的随机分组方法分为右美托咪啶负荷组(D1组)、右美托咪啶负荷加维持组(D2组)及安慰剂组(P组)共3组,各30例。D1组和D2组手术开始前30 min静脉泵注50 ml DEX 0.5μg/kg负荷剂量,P组给予50 ml生理盐水,15 min泵注完。D2组静脉泵注完负荷剂量后,持续泵注0.125 ml·kg^(-1)·h^(-1)含4μg/ml(0.5μg·kg^(-1)·h(-1))DEX的生理盐水至手术结束;D1组和P组静脉泵注完负荷剂量后,持续泵注生理盐水0.125 ml·kg^(-1)·h^(-1)至手术结束。手术开始前根据OAA/S镇静评分、VAS镇痛评分予静脉注射咪达唑仑、芬太尼,比较3组患者咪达唑仑、芬太尼的用量及手术满意度。结果 D1组、D2组、P组加用咪达唑仑例数分别为24例(80.0%)、22例(73.3%)、30例(100%),咪达唑仑用量分别为(1.52±0.94)mg、(0.93±0.65)mg、(3.88<0.89)mg。D1、D2组加用咪达唑仑例数明显少于P组(P<0.05),咪达唑仑用量也明显少于P组(P<0.05),D2组较D1组咪达唑仑用量更少(P<0.05)。3组所有患者均需加用芬太尼,用量分别为(0.15±0.06)mg、(0.12±0.05)mg、(0.23±0.09)mg,D1、D2组芬太尼用量明显少于P组(P<0.05),D1和D2组间比较差异无统计学意义。D1及D2组的高血压、心动过速、呼吸抑制的发生率明显低于P组(P<0.05),但D1和D2组间比较差异无统计学意义。D1及D2组对手术过程的满意度比P组高(P<0.05),但D1和D2组组间比较差异无统计学意义。结论乳腺局部活检手术中,右美托咪啶负荷用药和负荷加维持用药,均能减少咪达唑仑和芬太尼的用量及其循环、呼吸抑制等不良反应的发生,增加患者手术满意度,右美托咪啶负荷加维持用药追加咪达唑仑的用量最少。

Objective To evaluate the safety and efficacy of dexmedetomidine for sedation of patients undergoing breast local biopsy requiring monitored anesthesia care（MAC）.Methods Ninty patients were randomly divided into group D1（DEX 0.5μg/kg loading dose,followed by a maintenance infusion of 0.125 ml·kg-1·-h-1 saline）,group D2（DEX 0.5μg/kg initial loading dose,followed by a maintenance infusion of 0.5μg·kg-1·h-1）,or group P（quivalent volume of saline placebo） titrated to a targeted level of sedation and pain.Study drug was started 30 min before placement of local anesthetic block.Midazolam was given for OAA/S〉4 and fentanyl for VAS〉4.The midazolam and fentanyl requirements,respiratory depression,and patient’s satisfaction of surgical procedure were recorded. Restlts Significantly fewer patients in group D1 and group D2 required supplemental midazolam compared with group P（P〈0.05） and at lower doses to achieve an OAA/S≤4 before and during surgery compared with group P（P〈0.05）.Group D2 required the lowest doses to achieve an OAA/S≤4 compared with group Dl（P〈0.05）.Both group D1 and group D2 required significantly less fentanyl and patient satisfaction was significantly higher with both group Dl and D2 compared with group P（respectively,P〈0.05）.The incidence of clinically significant tachycardia,hypertension and respiratory depression were lower in group D1 and D2 compared with group P（respectively,P〈0.05）.Conclusions DEX is an effective baseline eadative for patients undergoing MAC for breast local biopsy providing better patient satisfaction,less midazolam and fentanyl requirements,and less circulation,respiratory complica-tion. Loading dose and followed by a maintenance infusion of DEX require the lowest doses than placebo rescured with midazolam.