右美托咪定联合表面麻醉在Becker痣激光治疗中的应用

Application of dexmedetomidine combined with superficial anesthesia in laser therapy for Becker's nevus

目的评价右美托咪定联合复方利多卡因乳膏表面麻醉在激光治疗Becker痣中的麻醉效果。方法选择30例Becker痣患者,随机分成两组各15例,实验组采用右美托咪定联合5%复方利多卡因乳膏麻醉,对照组采用5%复方利多卡因乳膏行表面麻醉,两组均采用Q开关Nd:YAG激光垂直移动照射术区,终点反应以治疗区域出现灰白为宜。采用视觉模拟评分法(VAS)对患者进行评估,采用调查问卷调查患者对麻醉方法的认可情况,连续监测并记录患者麻醉前、使用右美托咪定后、激光治疗即刻、激光术后的心率(HR)、动脉血氧饱和度(Sp O2)、平均动脉压(MAP),对比观察两组临床疗效。结果术后实验组的VAS评分显著低于对照组(P<0.001),实验组的麻醉效果优于对照组。两组患者对麻醉方法的认可率比较差异有统计学意义(P<0.05),实验组患者对麻醉方法的认可率高于对照组。经过3次治疗后,实验组患者总有效率为73.3%,对照组总有效率为40%,两组比较差异无统计学意义(P>0.05)。实验组患者使用右美托咪定后均有不同程度的心率减慢和平均动脉压下降,但保持平稳,动脉血氧饱和度未见异常。对照组患者在激光治疗过程中,出现不同程度的心率加快和平均动脉压升高,但未超出正常波动范围,动脉血氧饱和度未见异常。结论右美托咪定联合5%复方利多卡因乳膏用于激光治疗Becker痣的麻醉效果优于单用乳膏组。

Objective To evaluate analgesic effect of dexmedetomidine combined with compound xylocaine cream by su- perficial anesthesia in laser therapy for Becker＇s nevus.Methods 30 patients with Becker＇ s nevus were selected, and they were randomly divided into experimental group and control group, with 15 cases in each. The experimental group were given anesthesia by dexmedetomidine combined with 5% compound xylocaine cream,while the control group were given superficial anesthesia by 5% compound xylocaine cream only. Operative region was exposed by Q-switched Nd：YAG laser with vertical movement. Reactions of end point appearing grayish white in therapy area was regarded to be appropriate. Visual analogue scale （VAS） was used to evaluate the patients, questionnaire was used to investigate patients＇ recognition on anesthetic meth- ods.In addition,heart rate （HR） ,arterial oxygen saturation（ SpO2 ）, mean arterial pressure（MAP） were continuously moni- tored and recorded before anesthesia, after use of dexmedetomidine, at the time of laser treatment and after laser treatment. Furthermore, clinical effects of both groups were observed and compared.Results After operation, VAS score of the experi- mental group were obviously lower than that of the control group（P〈O.001 ） ,and anesthetic effect was superior to that of the control group.There were statistically significant differences in the recognition rates of the two groups（P〈0.05）, that of the ex- perimental group was significantly higher than that of the control group.After 3 times of treatment, total effective rate of the ex- perimental group was 73.3%, and that of the control group was 40%, difference was not statistically significant（P〉0.05） .The experimental group treated with dexmedetomidine had different degrees of decreased heart rate and low mean arterial pres- sure ,but it was stable and there was no abnormal arterial oxygen saturation.HR and mean arterial pressure of the control group increased in different degrees during laser treatment, but they were not beyond the normal range of fluctuations, no abnormalities were found in arterial oxygen saturation.Conelusion The analgesic effect of dexmedetomidine combined with 5% compound lidocaine cream was superior to single use of compound lidocaine cream during laser therapy of Becket＇ s nevus.