右美托咪定联合氟比洛芬酯用于局麻下甲状腺切除术患者的临床观察

Clinical observation of dexmedetomidine combined with flurbiprofen axetil in partial-thyroidectomy under local anesthesia

目的观察右美托咪定(Dexmedetomidine,DEX)联合氟比洛芬酯(Flurbiprofen axetil,FA)用于局麻下甲状腺部分切除术患者辅助镇静镇痛的安全性和有效性。方法选择局部浸润麻醉下甲状腺部分切除术成年患者60例,ASA分级为Ⅰ或Ⅱ级,随机分为2组,每组30例。DF组患者在开通静脉通路后FA 50 mg经静脉滴注,之后DEX负荷量1μg/(kg·min)10 min泵入,后改为0.5μg/(kg·h)泵注维持;D组患者在开通静脉通路后DEX负荷量1μg/(kg·min)10 min泵入,后改为0.5μg/(kg·h)泵注维持。记录患者入室开通静脉通路10 min基础值(T0)、DEX负荷量泵入10 min时(T1)、术区局麻时(T2)、切皮时(T3)、甲状腺部分切除时(T4)和缝皮时(T5)的收缩压(SBP)、舒张压(DBP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO2),以及VAS评分、Ramsay评分、OAA/S评分和术后并发症等情况。结果术中DF组多时间点SBP、HR较D组同期值低(P<0.05),DBP、RR和SpO2组间比较差异无统计学意义(P>0.05)。术中VAS、Ramsay评分DF组优于D组(P<0.05);而OAA/S评分与D组比较差异无统计学意义(P>0.05)。术后VAS、Ramsay评分DF组优于D组(P<0.05);DF组满意度优秀率高于D组(P<0.05)。结论 DEX联合FA用于局麻下甲状腺部分切除术,患者生命体征平稳,能辅助提供良好的术中镇静、镇痛效果,FA术后仍然具有镇痛效应,未见明显不良反应,DEX联合FA用于局麻下甲状腺部分切除术患者辅助镇静镇痛安全、有效。

Objective To observe the advantage of dexmedetomidine（DEX） combined with flurbiprofen axetil （FA） in partial-thyroidectomy patients. Methods The selective 60 partial-thyroidectomy patients with local anesthesia were randomly divided into 2 groups ： experiment group （ group DF, n = 30 ） and contrast group （ group D, n = 30 ）. In group D, the patients received intravenous injection of Dex （1 μg/kg）10 minutes directly and then received continuous injection of Dex at a rate of 0. 5 μg/（ kg- h）. While in group DF, the patients received intravenous injection of FA 50 mg firstly, then intravenous injection of Dex the same as in group D. Systolic blood pressure（ SBP）, diastole blood pres sure （DBP） , heart rate （HR） , respiration rate （ RR ） , pulse oxygen saturation （ SpO2 ）, VAS score, Ramsay score, OAA/S score and complication of post surgery were determined at 10 rain after entering the operation room（ TO ）, at 10 min after receiving load dose Dex（ T1 ） ,the time of local anesthesia（ T2 ） and cutting the skin（ T3 ）, at partial-thyroidectomy （ T4 ） and suturing the skin （ T5 ）. Results SBP, HR of group DF at T2 - T5 were lower than those in group D at the same time points （P 〈 0. 05 ）, DBP, RR and SpO2 showed no statistically significant difference between the two groups （ P 〉 0. 05 ）. During operation, VAS score and Ramsay score of group DF were better than those of group D （ P 〈 0. 05 ） , while OAA/S score showed no statistically significant difference between the two groups （ P 〉 0. 05 ）. VAS score and Ramsay score of group DF were better than those of group D after operation（ P 〈 0. 05 ）. The excellent rate of satisfaction degree was higher in group DF than that of group D （ P 〈 0. 05 ）. Conclusion Dex combined with FA in partial-thyroidectomy with local anesthesia, it is efficacy and safety because of the stable patients＇vital sign ,better sedation score and visual analogue scale during operation without obvious complication.