右美托咪定联合咪达唑仑在阑尾切除术麻醉镇静中的价值

The sedation values of dexmedetomidine combined with midazolam in the management of appendectomy

目的研究右美托咪定联合咪达唑仑在阑尾切除术麻醉镇静中的价值。方法前瞻性收集急性阑尾炎患者90例，将患者按随机数字表法分为右美托咪定联合咪达唑仑组、单纯咪达唑仑组和单纯右美托咪定组。比较三组患者术中血流动力学变化。结果三组患者t0时心率和平均动脉压差异无统计学意义（P〉0．05）。与单纯咪达唑仑组和单纯右美托咪定组比较，右美托咪定联合咪达唑仑组患者t1心率显著降低[（79．73±10．36）次／min比（93．30±19．32）次／min和（90．85±18．23）次／min，F=5．796，P=0．004]；t3时心率显著降低[（79．51±11．21）次／min比（87．53±18．35）次／min和（95．03±14．64）次／min，F=8．006，P=0．001]；t5时心率显著降低[（79．73±12．24）次／min比（91．80±17．71）次／min和（89．62±14．26）次／min，F=5．584，P=0．005]；t2和t4时心率有降低趋势，但差异无统计学意义（P〉0．05）；t1、t2、t3、t4和t5时平均动脉压显著降低（F值分别为8．444、6．591、8．165、17．121和6．977，P值分别为0．000、0．002、0．001、0．000和6．977）；疼痛视觉模拟评分显著降低[（3．40±1．28）分比（4．50±1．81）分和（4．37±1．71）分，F=4．131，P〈0．05]；手术时间显著缩短[（111．17±15．77）min比（129．33±13．98）min和（132．50±14．67）min，F=0．000，P〈0．05）；出血量显著减少[（202．47±61．07）mL比（246．87±52．06）mL和（241．93±58．71）mL，F=0．006，P〈0．05）。结论右美托咪定联合咪达唑仑更有助于维持患者血流动力学稳定，显著降低了手术时间、术中出血量和疼痛视觉模拟评分。

Objective To investigate the sedation values of dexmedetomidine combined with midazolam in appendectomy. Methods 90 patients with acute appendicitis were studied prospectively. According to the principle of completely random digital table, all patients were randomly signed into the dexmedetomidine combined with midazolam group, single midazolam group or single dexmedetomidine group. The hemodynamic changes in the three groups were compared. Results There were no significant differences in the three groups in heart rate and mean arterial pressure at t0 （ P 〉 0.05 ）. When compared with the single midazolam group or dexmedetomidine group, patients in dexmedetomidine group got a significant reduction in heart rate at tl [ （79.73 ± 10.36） beat/min vs. （93.30 ± 19.32） beat/min and （90.85 ± 18. 23）beat/min, F =5.796,P =0.004];at t3 [（79.51 ± 11.21）beat/min vs. （87.53 ± 18.35 ） beat/min and （95.03 ± 14.64） beat/min, F = 8. 006,P = 0.001 ] ;and at t5 [ （79.73 ± 12.24 ） beat/min vs. （91.80 ± 17.71 ） beat/min and （ 89.62 ± 14.26 ） beat/min, F = 5. 584, P = 0. 005 ] ; a reduction in heart rate at t2 and t4, though there was no statistical difference （ P 〉 0.05 ） ; a significant reduction in mean arterial pressure at t1, t2, t3, t4 and t5 （ F = 8. 444,6.591,8. 165,17.121 and 6. 977, P = 0.000,0. 002,0. 001,0.000 and 6. 977 ） ; a significant reduction in visual analogue scales [ （ 3.40 ± 1. 28 ） points vs. （ 4.50 ± 1. 81 ） points and （ 4. 37 ± 1.71）points,F= 4. 131,P 〈 0. 05];a significant reduction in operation duration [（ 111. 17 ± 15.77）min vs. （ 129. 33 ± 13.98 ） rain and （ 132.50 ± 14.67 ） min, F = 0.000, P 〈 0.05 ] ; and a significant reduction in bleeding volume [（202.47±61.07）mL vs. （246.87 ±52.06）mL and （241.93 ±58.71）mL, F=0. 006,P〈0.05]. Conclusion Dexmedetomidine combined with midazolam contributed to maintaining the hemodynamic stable and reducing the operation duration,intra -operation bleeding volume and visual analogue scales.