右美托咪定联合胸椎旁神经阻滞在乳腺手术中的临床应用

Clinical application of dexmedetomidine combined with thoracic paravertebral blockade in breast surgery

目的探讨右美托咪定联合胸椎旁神经阻滞应用于乳腺手术的有效性及安全性。方法选择行乳腺手术患者90例,用随机余数法分为三组,每组30例,即右美托咪定组(D组)、咪达唑仑组(M组)和对照组(C组)。D组与对照组分别于胸椎旁神经阻滞前15 min开始静脉注入等剂量的右美托咪定(负荷量0.5μg/kg、10 min内注完)及生理盐水,M组于胸椎旁神经阻滞前15 min静脉注入咪达唑仑0.1 mg/kg,观察并记录入室(T0)、胸椎旁神经阻滞穿刺前(T1)、切皮(T2)、肿块切除(T3)、手术结束(T4)时的心率(HR)、呼吸(RR)、平均动脉压(MAP)、Sp O2和警觉/镇静评分(OAA/S)。结果与对照组比较,D组T1-T4时MAP明显降低、HR明显减慢;T2、T3时RR明显增快(P<0.05);D组T2时Sp O2明显高于M组和对照组(P<0.05)。T1-T4时的M组和T1、T2时的D组OAA/S评分明显低于对照组(P<0.05)。结论右美托咪定可安全有效地应用于胸椎旁神经阻滞下乳腺手术的辅助镇静。

Objective To explore the effectiveness and safety of dexmedetomidine combined with thoracic paravertebral blockade in breast surgery.Methods Ninty patients undergoing breast surgery were randomly divided into three groups （n =30 in each group）：dexmedetomidine group,midazolam group and control group.The patients were intravenously administered with isodose dexmedetomidine（0.5 μg/kg,finish within 10 min）in dexmedetomidine group,midazolam（0.1 mg/kg）in midazolam group and normal saline in control group 15 min before thoracic paravertebral blockade respectively.The heart rate （HR）,respiration rate （RR）,mean arterial pressure（MAP）,SpO2 and observer assessment of sedation（OAA/S） were recorded before puncture of thoracic paravertebral blockade （T1）,during skin incision （T2）,during lumpectomy （T3） and after surgery （T4）.Results Compared with control group,MAP and HR in dexmedetomidine group decreased significantlly from T1 to T4,while RR increased at T2 and T3 （P ＜ 0.05）.SpO2 was significantly higher in dexmedetomidine group than those in midazolam group and control group at T2 （P ＜ 0.05）.OAA/S score in midazolam group at T1-T4 and OAA/S score in dexmedetomidine group at T1 and T2 were significantly lower than those in control group （P ＜ 0.05）.Conclusion Dexmedetomidine can be used as a safe and effective auxiliary sedative in breast surgery with thoracic paravertebral blockade.