不同剂量右美托咪定复合瑞芬太尼在前列腺穿刺活检术中的清醒镇静效果

Conscious sedation efficacy of Dexmedetomidine at different doses combined with Remifentanil during transrectal prostatic biopsy

目的观察不同剂量盐酸右美托咪定注射液(右美托咪定)复合盐酸瑞芬太尼(瑞芬太尼)在经直肠超声引导下前列腺穿刺活检术中的清醒镇静效果。方法选择中南大学湘雅医学院附属海口医院90例择期行经直肠超声引导下前列腺穿刺术的患者,根据右美托咪定使用剂量的不同随机分为3组,每组各30例,分别于术前15 min静脉输注0.5μg/kg(D_(1)组)、0.3μg/kg(D_(2)组)和0.2μg/kg(D_(3)组)的右美托咪定,10 min输注完毕,并于术前10 min以0.1μg·kg^(-1)·min^(-1)的速度持续静脉输注瑞芬太尼至术毕。观察并记录手术时间、镇痛优秀率及麻醉前(T_(0))、麻醉给药后15 min(T_(1))、超声探头置入时(T_(2))、穿刺针穿破前列腺包膜时(T_(3))、手术结束后5 min(T_(4))的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)、Ramsay镇静评分,以及术中不良反应,如体动、呼吸抑制(SpO2≤92%)、低血压、心动过缓(HR≤50次)、术后谵妄的发生情况。结果D_(1)组T_(1)~T_(4)时点MAP、HR较T_(0)时点明显降低(P<0.05);D2、D_(3)组T_(1)时点MAP、HR较T_(0)时点明显降低(P<0.05);D_(1)组T_(2)、T_(4)时点MAP、HR较D_(3)组明显降低(P<0.05);D_(1)组T_(1)~T_(4)时点Ramsay镇静评分较T_(0)时点明显升高(P<0.05);D_(1)组T_(1)~T_(2)时点Ramsay镇静评分较D_(3)组T_(1)、T_(2)时点明显升高(P<0.05)。D_(3)组术中呼吸抑制、体动发生率高于D_(1)、D2组(P<0.05),镇痛优秀率低于D_(1)、D2组(P<0.05);D_(1)组术中心动过缓、低血压发生率高于D_(3)组(P<0.05);3组术后谵妄发生率比较差异无统计学意义(P>0.05)。结论0.3μg/kg的右美托咪定复合0.1μg·kg^(-1)·min^(-1)的瑞芬太尼持续静脉输注,可为经直肠超声引导下前列腺穿刺活检术提供安全有效的清醒镇静。

Objective Conscious sedation efficacy of Dexmedetomidine at different doses combined with Remifentanil was observed during transrectal ultrasound-guided prostatic biopsy.Methods Ninety patients scheduled for transrectal ultrasound-guided prostatic biopsy were randomly divided into three groups,i.e.medium-dose Dexmedetomidine group(0.5μg/kg,group D_(1)),low-dose Dexmedetomidine group(0.3μg/kg,group D_(2))and another low-dose Dexmedetomidine group(0.2μg/kg,group D_(3)),there were 30 cases in each group.Dexmedetomidine was given 15 mins before surgery over 10 mins respectively in each group and Remifentanil was given 10 mins before surgery at the speed of 0.1μg·kg^(-1)·min^(-1) until the surgery finished.The following outcomes were observed and recorded,including operation time,perfect analgesic ratio,heart rate(HR),mean artery blood pressure(MAP),oxyhemoglobin saturation(SpO_(2)),Ramsay sedation score before anesthesia(T_(0)),15 mins after drug administration(T_(1)),when inserting the ultrasonic probe(T_(2)),when breaking through the prostate capsule(T_(3))and 5 mins after the operation(T_(4))as well as adverse reactions such as body movement,respiratory depression,bradycardia,hypotension and postoperative delirium.Results MAP and HR at T_(1)-T_(4) in group D_(1) were lower than those at T_(0)(P<0.05).MAP and HR at T_(1) in group D2 and group D_(3) were lower than those at T_(0)(P<0.05).MAP and HR at T_(2) and T_(4) in group D_(1) were lower than those in group D_(3)(P<0.05).Ramsay sedation score at T_(1)-T_(4) in group D_(1) were higher than those at T_(0)(P<0.05),and ramsay sedation score at T_(1)-T_(2) in group D_(1) were higher than those in group D_(3)(P<0.05).The incidences of respiratory depression and body movements in group D_(3) was higher than those in group D_(1) and group D2(P<0.05).The perfect analgesic ratio in group D_(3) was lower than those in group D_(1) and group D2(P<0.05).The incidences of bradycardia and hypotension in group D_(1) was higher than those in group D_(3)(P<0.05).There were no significant differences in the incidences of nausea and vomiting and postoperative delirium among three groups(P>0.05).Conclusion 0.3μg/kg Dexmedetomidine combined with 0.1μg·kg^(-1)·min^(-1) of Remifentanil continuous intravenous infusion could offer safety and efficient conscious sedation and analgesia for transrectal ultrasound guided prostatic biopsy.