不同剂量的右美托咪啶和咪唑安定在口腔种植手术中的镇静效果

Application of different doses of dexmedetomidine and midazolam in dental implant surgery

目的：比较不同剂量的右美托咪啶与咪唑安定在口腔种植手术患者中的镇静效果。方法选择60例需行口腔种植牙的健康患者，随机分为6组，每组10例。1组（G1）单独使用高剂量咪唑安定；2组（G2）低剂量咪唑安定复合低剂量右美托咪啶；3组（G3）高剂量咪唑安定复合高剂量右美托咪啶；4组（G4）为低剂量咪唑安定复合高剂量右美托咪啶；5组（G5）为高剂量咪唑安定复合低剂量右美托咪啶；6组（G6）单独使用高剂量右美托咪啶。记录各组镇静前、手术中、手术结束时患者血压、心率、血氧饱和度。记录并比较各组局部麻醉（T1）、切开（T2）、备洞（T3）、缝合（T4）时患者Ramsay镇静评分（RSS）以及对T1～T4的记忆情况，离院前进行手术疼痛评分及患者满意度调查。结果 G3组收缩压在T1～T4时均低于G1、G2组（P＜0.05）；G1组收缩压在T3、T4时高于G6组（P＜0.05）。G3组术中心率低于术前（P＜0.05）。T1～T4时G1组RSS评分最低；G2组多为2～3分；G3组镇静较深，多例达到5分；G4组以3～4分居多；G5组在T2时开始有部分达到5分；G6组在T1、T2时低于G3、G4、G5组，在T2时接近G4组。各组疼痛评分及麻醉手术满意度比较未见差异。结论联合使用右美托咪啶和咪唑安定镇静优于单独使用，低剂量咪唑安定联合高剂量右美托咪啶镇静效果及程度最满意。

Objective To compare the sedative effects of different doses of dexmedetomidine （DEX） and midazolam （MDZ） in dental implant surgery. Methods Sixty patients undergoing dental implantation were selected and divided randomly into six groups （10 in each group）. In group 1 （G1）, a highdose of MDZ alone was administered intravenously. In group 2 （G2）, a relatively low dose of MDZ and DEX was administered intravenously. In group 3 （G3）, a highdose of MDZ and DEX was ad- ministered intravenously. In group 4 （G4）, a lowdose of MDZ and a highdose of DEX were administered. In group 5（G5）, a highdose of MDZ and a low dose of DEX were administered. In group 6 （G6）, a highdose of DEX alone was administered intravenously. Blood pressure （BP）, heart rate （HR）, and arterial oxygen saturation values were measured. Sedation was as- sessed by determining the Ramsay sedation scores（RSS） during infiltration anesthesia （T1）, incision （T2）, cutting （T3）, and suturing （T4）. Before discharging from the hospital, patients were asked if they remembered the T1 to T4 procedures. The visual analogue scale （VAS） and the degree of patient satisfaction were assessed at the same time. Results In T1 to T4, the systolic blood pressure （SBP） in G3 was the lowest and was significantly different from that in G1 and G2 （P〈0.05）. In G1, the SBP was higher than that in G6 at the T3 and T4 points （P〈0.05）. HR was below the preoperative （P〈0.05） in the G3 only. RSS was the lowest in G1 during the whole procedure. In G2, most patients obtained scores of 2-3. In G3, sedation was deeper, had more cases of up to 5. In G4, most patients obtained scores of 3-4. In G5, some patients had a score of up to 5. The RSS in G6 was lower than that in G3 and G4 or G5 in T1 to T2, closer to G4 in T2. An evaluation of the VAS and the degree of patient satisfaction did not show any differences among the groups. Conclusion The combination of DEX and MDZ is superior to a single intravenous injection. Low-dose MDZ combined with high-dose DEX achieved the highest quality of sedation in this study.