不同剂量右美托咪定用于帕金森病患者脑深部电刺激术镇静效果的比较

Comparison of efficacy of different doses of dexmedetomidine for sedation in patients with Parkinson's disease undergoing deep brain stimulation surgery

目的比较不同剂量右美托咪定用于帕金森病患者脑深部电刺激术镇静的效果。方法择期行脑深部电刺激术帕金森病患者75例,ASA分级Ⅱ或Ⅲ级,年龄48~72岁,BMI 18~24kg/m^2,性别不限,采用随机数字表法分为3组(n=25):0.3、0.5和0.8μg·kg^-1·h^-1右美托咪定组(D1组、D2组和D3组)。D1-3组于0.25%罗哌卡因10~20ml局部浸润麻醉前10min静脉输注右美托咪定负荷剂量0.5μg/kg,随后各组以0.3、0.5和0.8μg·kg^-1·h^-1的速率静脉输注,神经学测试期间暂停输注右美托咪定,唤醒患者,测试完毕后维持原剂量至术毕。于麻醉前即刻(T0)、唤醒前停药即刻(T1)及神经学测试(T2)时记录BIS值;记录唤醒时间、补救镇静、SpO2<90%和打鼾的发生情况。结果与D1组比较,D2组和D3组补救镇静率和T1,2时BIS值降低,D3组唤醒时间延长,SpO2<90%和打鼾发生率升高(P<0.05或0.01);与D2组比较,D3组补救镇静率和T1时BIS值降低,唤醒时间延长,SpO2<90%和打鼾发生率升高(P<0.05或0.01)。结论0.5μg·kg^-1·h^-1右美托咪定用于帕金森病患者脑深部电刺激术可产生良好的镇静效果,且安全性较好。

Objective To compare the efficacy of different doses of dexmedetomidine for sedation in patients with Parkinson′s disease(PD)undergoing deep brain stimulation(DBS)surgery.Methods Seventy-five patients of both sexes with PD,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 48-72 yr,with body mass index of 18-24 kg/m^2,undergoing elective DBS surgery,were divided into 3 groups(n=25 each)using a random number table method:different doses of dexmedetomidine groups(D1-3 groups).Dexmedetomidine was intravenously infused in a loading dose of 0.5 μg/kg at 10 min before local infiltration anesthesia with 0.25 % ropivacaine 10-20 ml,followed by an infusion of 0.3,0.5 and 0.8 μg·kg^-1·h^-1 in D1-3 groups,respectively.The infusion of dexmedetomidine was suspended during neurological test,the patients were awakened,and dexmedetomidine was infused at 0.3,0.5 and 0.8 μg·kg^-1·h^-1 until the end of the surgery after the test.Bispectral index(BIS)value was recorded immediately before anesthesia(T0),immediately after administration prior to wake-up(T1)and during neurological test(T2).The wake-up time and adverse reactions such as requirement for rescue analgesics,pulse oxygen saturation(SpO2)<90% and snoring were recorded.Results Compared with group D1,the requirement for rescue analgesics and BIS value at T1,2 were significantly decreased in D2 and D3 groups,and the wake-up time was significantly prolonged,and the incidence of SpO2<90% and snoring was increased in group D3(P<0.05 or 0.01).Compared with group D2,the requirement for rescue analgesics and BIS value at T1 were significantly decreased,the wake-up time was prolonged,and the incidence of SpO2<90% and snoring was increased in group D3(P<0.05 or 0.01).Conclusion Dexmedetomidine 0.5 μg·kg^-1·h^-1 can produce good sedative efficacy and safety for DBS surgery in patients with PD.