右美托咪定对局麻下甲状腺手术患者清醒镇静的效果评价

Effect of Conscious Sedation with Dexmedetomidine Combined with Infiltration Anaesthesia in Patients Undergoing Subtotal Thyroidectomy

目的:评价右美托咪定用于局麻下甲状腺手术患者清醒镇静的效果。方法:择期拟行甲状腺手术患者80例随机分为对照组(n=40)和研究组(n=40),研究组静脉注射右美托咪定,负荷量0.5μg/kg,再以0.6μg·kg-1·h-1的速率持续静脉输注,对照组给予同容量的生理盐水。手术开始时由术者以1%普鲁卡因术野局部浸润麻醉。术中两组患者每20 min间断追加芬太尼0.5μg/kg,必要时重复。记录两组手术时间、术中BP、HR和Sp O2的变化情况及辅助使用芬太尼的剂量。记录入室时(T1)、手术开始时(T2)、手术开始后30 min(T3)、手术结束时(T4)测定血糖的变化。以Ramsay镇静评分法评价患者的镇静程度。结果:两组患者均无呼吸抑制,术中研究组患者Ramsay镇静评分为3-4分,对照组患者Ramsay镇静评分为2分,两组患者均能呼之则应,保持发声。与对照组比较,研究组在T2、T3、T4等时间点血糖明显降低(P<0.05);研究组术中心动过速及高血压发生率明显低于对照组(P<0.05),术中芬太尼使用量明显降低(P<0.05)。结论:右美托咪定用于局麻下甲状腺手术患者清醒镇静的效果良好。

Objective： To evaluate the efficacy of conscious sedation with dexmedetomidine combined with infiltration anaesthesia in patients undergoing subtotal thyroidectomy . Methods： 80 patients underwent subtotal thyroidectomy were randomly assigned into control group（n=40,group C） and dexmedetomidine group（n=40,group D）. Dexmedetomidine was infused at a rate of 0.6 μg·kg-1＆·h-1 after a loading dose of 0.5 μg/kg in group D. In group C, normal soline of the same volume as group D was infused. Both groups were infiltrated with 1% procaine at the beginning of operation. A bolus of fentanyl 0.5 μg/kg was injected every 20 min and repeated according to need. Duration of operation,BP,HR,SpO2 and amount of fentanyl were recorded. Blood glucose was detected after admission to the operating room （T1）, at the beginning of operation（T2）, at 30 min afer skin incision（T3）, at the end of operation（T4）. The degree of sedation was evaluated with Ramsay sedation score. Results： There were no adverse respiratory events seen in either group C or D. Ramsay Sedation Scale score was 3-4 in group D, 2 in group C respectively. Both groups were kept voicing and painless and easily woken up. Compared with group C,blood glucose level was significantly lower at T2-4 in group D （P〈0.05）, the incidence of hypertension, tachycardia and amount of fentanyl were significantly decreased in group D （P〈0.05）. Conclusion： When combined with infiltration anaesthesia, dexmedetomidine can provide satisfactory efficacy of conscious sedation for subtotal thyroidectomy.