小剂量右美托咪定在口腔颌面部肿瘤患者经皮气管扩张术中的镇静镇痛效果

Effects of small dose of dexmedetomidine on sedation and analgesia in patients undergoing percutaneous dilatational tracheostomy before surgical treatment of oral and maxillofacial tumor

目的评价小剂量右美托咪定应用于经皮气管扩张术(PDT)中的安全性和有效性。方法口腔颌面部肿瘤术前接受PDT的患者40例,随机分为右美托咪定组和芬太尼组,分别静脉注射右美托咪定0.5μg/kg、芬太尼1μg/kg。两组负荷剂量后10 min行PDT。记录术前(T_0)和药物注射结束(T_1)两个时间点的警觉/镇静评分(OAA/S评分),T_0、T_1和扩张气管置入气管切开套管(T_2)3个时间点的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(S_pO_2)和呼吸频率(RR),术中心血管不良反应和呼吸抑制的发生例数。结果两组间年龄、体重及性别构成比的差异无统计学意义(P值均>0.05)。两组在T_1时间点的OAA/S评分均分别较同组T_0时间点显著下降(P值均<0.05),但两组间同时间点OAA/S评分的差异均无统计学意义(P值均>0.05)。右美托咪定组在T_1和T_2时间点的MAP、HR、S_pO_2和RR与同组T_0时间点的差异均无统计学意义(P值均>0.05),但T_2时间点的MAP和HR较芬太尼组同时间点显著下降(P值均<0.05)。芬太尼组在T1时间点的MAP、HR、S_pO_2和RR及T2时间点的S_pO_2和RR与同组T_0时间点的差异均无统计学意义(P值均>0.05),但T_2时间点的MAP和HR较同组T_0时间点显著上升(P值均<0.05)。右美托咪定组高血压(1/20)和心动过速(1/20)的发生率显著低于芬太尼组(7/20和8/20,P值均<0.05);其低血压(3/20)和心动过缓(4/20)的发生率略高于芬太尼组(0和2/20),但差异无统计学意义(P值均>0.05)。两组均未出现呼吸抑制。结论小剂量右美托咪定较芬太尼血流动力学更稳定,无明显呼吸抑制,可安全有效地用于已预测困难气道的口腔颌面部肿瘤患者术前行PDT的镇静、镇痛。

Objective To evaluate the safety and efficacy of small dose of dexmedetomidine （DEX） in the percutaneous dilatational tracheostomy （PDT）. Methods Forty patients undergoing PDT before surgical treatment of oral and maxillofacial cancer were randomized to DEX group and fentanil group （intravenous injection, 0.5 μg/kg DEX and 1μg/kg fentanil, respectively）. PDT began 10 min after drug infusion. Observer＇s assessment of alertness/sedation （OAA/S） scores at the base time （T0） and after drug infusion （T1） was calculated. Mean artery pressure （MAP）, heart rate （HR）, saturation pulse oxygen （SpO2） and respiratory rate （RR） at To, T1 and T2 （inserting dilation catherter）, intraoperative cardiovascular adverse reaction, and respiration depression were recorded. Results There were no significant differences in terms of age, body weight and sex ratio between two groups （P〉0.05）. OAA/S score at T1 was significantly lower than that at To in both two groups （P〈0.05）, but OAA/S score in DEX group was not statistically different from fentanil group at T1 （P〉0.05）. Compared with To, there were few changes of MAP, HR, SpO2 and RR at T1 and T2 in DEX group （P〉0.05）. But the MAP and HR at T2 in DEX group were significantly lower than that in the fentanil group （P〈0.05）. In the fentanil group, MAP, HR, SpO2and RR at T1 were not statistically diffenrent from those at To （P〉0.05）, but MAP and HR at T2 were significantly higher than those at T0 （P〈0.05）, SpO2 and RR at T2 were not statistically different from those at To （P〉0.05）. The incidence of hypertension and tachycardia in DEX group was significantly lower than that in fentanil group （P〈0.05）. There was no signifiant difference in the incidence of hypotension and bradycardia between the two groups （P〉0.05）. No respiratory depression happened in all the patients. Conclusion DEX is an effective sedative for the patients undergoing PDT before surgical treatment of oral and maxillofacial tumor. It can make hemodynamics more stable and cause less respiratory depression as compared with fentanyl. （Shanghai Med J, 2012, 35; 671-674）