右美托咪啶在子宫肌瘤患者HIFU治疗中的应用

Application of Dexmedetomidine in HIFU Treatment for Patients with Hysteromyoma

【目的】观察右美托咪啶（DEX）在子宫肌瘤高强度聚焦超声（HIFU）治疗术中应用的临床效果。【方法】180例择期行子宫肌瘤HIFU治疗术患者，年龄22～58岁，ASA分级I～II级，随机分为DEX组（D组）和对照组（C组），每组90例。D组于手术前20 min给予DEX负荷剂量0．8μg/kg ，随后以0．2μg/（kg ＆#183; h）的速率静脉输注至术毕，C组给予等容量0．9％氯化钠溶液。手术开始前及手术中根据OAA/S镇静评分、VAS镇痛评分予静脉注射咪达唑仑、芬太尼，比较两组患者咪达唑仑、芬太尼的用量，呼吸抑制及麻醉满意度（ISAS 评分）情况。【结果】D组与C组分别有59例（65．6％）和90例（100％）需要加用咪达唑仑，用量分别为（1．05＆#177;0．52）mg和（3．68＆#177;0．96）mg，D组用量少于C组（P ＜0．05）。所有患者均需追加芬太尼，D组与C组用量分别为（0．13＆#177;0．09）m g和（0．18＆#177;0．08）m g ，D组用量少于C组（ P ＜0．05）。D组有9例出现心动过缓，C组有4例，D组心动过缓发生率高于C组（ P＜0．05）。D组高血压、心动过速、呼吸抑制发生率明显低于C组（ P ＜0．05），D组ISAS评分高于C组（ P ＜0．05）。【结论】 DEX在子宫肌瘤患者 HIFU 治疗手术中可以减少咪达唑仑及芬太尼用量，减少呼吸抑制的发生，提高患者麻醉满意度。

[Objective]To observe the clinical efficacy of dexmedetomidine（DEX） in high intensity focused ul-trasound（HIFU） treatment for patients with hysteromyoma .[Methods]Totally 180 ASA Ⅰ ~ Ⅱ patients（aged 22~58 years old） with hysteromyoma scheduled for HIFU treatment were randomly divided into DEX group （group D ,n =90） and control group（group C ,n=90） .Group D was given intravenous infusion of DEX by 0 .2μg/（Kg . h） until the end of operation after a loading dose of 0 .8μg/kg at 20min before operation .Group C was infused with equal volume of 09% normal saline .According to OAA/A sedation score and VAS analgesia score ,midazolam and fentanyl were intravenously injected before and during the operation .The dosage of midazolam and fentanyl ,re-spiratory depression and anesthesia satisfaction （ISAS score） were compared between two groups .[Results] Mid-azolam was required in 58 patients （65 .6% ） in group D and 90 patients （100% ） in group C ,and the dose was （1 .05 ＆#177; 0 .52）mg and （3 .68 ＆#177; 0 .96）mg ,respectively .The dose of midazolam in group D was lower than that in group C（ P 〈0 .05） .All patients additionally required fentanyl ,and the dose was （0 .13 ＆#177; 0 .09）mg and （0 .18 ＆#177; 0 .08）mg ,respectively .The dose of fentanyl in group D was lower than that in group C （ P 〈 0 .05） .The inci-dence of tachycardia in group D was higher than that in group C （ P 〈0 .05） ,while the incidence of hypertension and respiratory depression in group D was lower that in group C （ P 〈0 .05） .ISAS score in group D was higher than that in group C（ P 〈0 .05） .[Conclusion]DEX used in HIFU treatment of patients with hysteromyoma can reduce the dose of midazolam and fentanyl ,decrease the incidence of respiratory depression and increase anesthesia satisfaction of patients .