右美托咪定自控镇静在老年男性经尿道前列腺汽化术中的应用

Utility of patient-controlled dexmedetomidine sedation in elderly patients with transurethral vaporization of the prostate

目的探讨右美托咪定自控镇静应用于腰硬联合麻醉下行TUVP的老年患者的镇静效果。方法选择择期行TUVP的老年患者80例,ASAⅠ-Ⅱ,采用随机数字表法,将其分为自控镇静组（P组）和麻醉医师控制镇静组（A组）,每组40例,在确定麻醉平面稳定后给予初始剂量的生理盐水右美托咪定溶液（右美托咪定4μg/ml）,P组（负荷预充量5 ml＋维持输注量2 ml/h＋单次给药量0.5 ml＋锁时设定30 s）,A组患者用输注泵给予右美托咪定[负荷预充量0.5μg/kg＋维持输注量0.5μg/（kg·h）]。记录下每位患者镇静开始前（T0）,负荷剂量输注完成即刻（T1）,手术开始（T2）、手术开始后10 min（T3）、20 min（T4）、30 min（T5）,术毕（T6）的MAP、HR、BR、Sp O2、BIS、镇静评分、合作评分和总用药量。结果与T0相比,P组T1-T5时及A组T1-T6时BIS值明显降低、镇静评分和合作评分明显升高（P〈0.05）;与A组相比,P组T1-T5时的BIS值明显升高（P〈0.05）;镇静评分明显降低（P〈0.05）,但患者合作评分差异无统计学意义（P〉0.05）;2组总用药量P组为（12.3±9.2）ml,低于A组的（15.5±2.4）ml（P〈0.05）。结论在老年患者TUVP中,右美托咪定自控镇静的镇静效果优于控制镇静,节约用药并实现了用药个体化。

Objective To explore the utility of patient controlled sedation（ PCS） with dexmedetomidine in eldly patients with transurethral vaporization of the prostate（ TUVP）. Methods Eighty patients,ASA Ⅰ- Ⅱ,scheduled for TUVP,were randomized into patient controlled sedation group（ group P） and anesthesia physician controlled sedation group（group A）,with 40 cases in each group. An initial dose of the mixed solution（ NS and dexmedetomidine containing dexmedetomidine 4 μg / ml） was given to the patients in both groups through intravenous infusion after the anesthesia plane was stable. Group P：loading dose 5 ml ＋ maintenance dose 2 ml / h ＋ single dose 0. 5 ml ＋ lock time 30 s;Group A：loading dose 0. 5 μg / kg ＋ maintenance dose 0. 5 μg /（ kg · h）. MAP,HR,BR,Sp O2,BIS,sedation score,cooperation score and the total dosage were documented before the initial sedation（ T0）,the moment of finishing infusing a loading dose（ T1）,the beginning of the operation（T2）,10 min（T3） 20 min（T4） 30 min（T5） after the beginning of the operation,the end of the operation（ T6）. Results When compared with T0,BIS values of group P at T1- T5 and group A at T1- T6 were significantly lower（ P 〈0. 05）,sedation score and cooperation score were significantly higher（ P 〈0. 05）.When compared with group A,BIS values of group P were significantly higher at T1- T5（P 〈0. 05） and sedation score were significantly lower（ P 〈0. 05）,while there was no statistical significiant in cooperation score of the two groups（ P 〉0. 05）. The total dosage of group P（12. 3 ± 9. 2） ml was less than（15. 5 ± 2. 4） ml in the group A（ P 〈0. 05）. Conclusion Patient-controlled sedation with dexmedetomidine showed better sedation results less dosage than anesthesia physician controlled sedation and to achieve a dosage individualized during TUVP in aged patients.