右美托咪定联合瑞芬太尼镇静镇痛用于长时间脂肪抽吸手术的临床观察

Clinical observation of sedative and analgesic anesthesia using dexmedetomidine combined with remifentanil for long-term liposuction surgery

目的 观察评价右美托咪定联合瑞芬太尼程序化镇静镇痛麻醉用于长时间吸脂手术的有效性和安全性。方法 共160例 ASA分级Ⅰ和Ⅱ级,年龄18~57岁,择期在程序化镇静镇痛麻醉下行脂肪抽吸术的女性患者,按照手术时间的长短分为长时组(GL组)和短时组(GS组),每组80例。两组患者麻醉方法相同,麻醉开始时静脉予咪达唑仑0.04 mg/kg,以0.1 μg/(kg·min)恒速泵注瑞芬太尼,同时静脉输注右美托咪定负荷量1μg/kg(15min输注完),后以0.4~0.7 μg/(kg·h)静脉持续泵注。分别记录患者在给药前即刻(T0)、右美托咪定负荷剂量输注完成后即刻(T1)、局麻开始(T2)、手术开始(T3)、停止输注右美托咪定即刻(T4)、手术结束(T5)各时间点的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、血氧饱和度(SpO)、脑电双频谱指数(BIS)、Ramsay镇静评分(RSS);记录患者术中出现呼吸抑制、面罩吸氧、托下颌的情况和最低呼吸频率;记录患者术中体动发生的次数、术后苏醒时间、对手术有无记忆、视觉模拟疼痛评分(VAS)及患者和术者的满意度评分。结果:两组患者术中均获得较为满意的镇静镇痛效果,术中维持RSS评分2~4分,BIS值62~75,在T4、T5时间点,GL组的HR和MAP显著高于GS组(P<0.05);在T1、T2时间点,GL组的RR和RSS评分均显著低于GS组(P<0.05);在T2、T5时间点,GL组的BIS显著低于GS组(P<0.05)。两组患者术中最低呼吸频率、呼吸抑制、面罩吸氧、托下颌发生率及体动次数、术后苏醒时间、对手术记忆的发生率、术后VAS评分、患者和术者的满意度评分的差异均无统计学意义(P>0.05)。结论 右美托咪定联合瑞芬太尼程序化镇静镇痛麻醉可以安全、有效应用于长时间脂肪抽吸手术,其麻醉不良反应发生率与短时间手术无明显差异。

Objective To observe and evaluate the efficacy and safety of procedural sedation and analgesia for long-term liposuction surgery using dexmedetomidine combined with remifentanil.Methods A total of 160 female patients with American Society of Anesthesiologists grade I and II,aged 18-57 years,scheduled for elective liposuction under procedural sedation and analgesia were divided into long-term group (GL group) and short-term group (GS group) according to the expected operation time,80 patients were included in each group.All patients received the same anesthesia method.At the beginning of anesthesia,midazolam 0.04 mg/kg was given intravenously,remifentanil was pumped at a constant rate of 0.1μg/(kg·min),and a loading dose(1μg/kg) of dexmedetomidine(DEX) was intravenously infused (completed within 15 minutes),and then continuously infused intravenously with the speed of 0.4~0.7μg/(kg·h).Heart rate (HR),mean arterial pressure (MAP),respiratory rate (RR),pulse oximetry (SpO),ispectral index (BIS),Ramsay sedation score (RSS) were evaluated and recorded before anesthesia (baseline) (T0),immediately after induction with DEX (T1),the beginning of local anesthesia (T2),the beginning of surgery (T3),immediately after turning off DEX infusion (T4),and the end of surgery (T5).The lowest respiratory rates (LRR),incidences of respiratory depression (RR<10 breaths/min),incidences of oxygen supplementation by facial mask and thrusting the jaw,frequencies of body movements were also recorded throughout the procedure.After surgery,recovery time,recall of intraoperative events,and postoperative VAS score in PACU were assessed.The satisfaction of patients and surgeons with the anesthesia were assessed using a 5-point numerical rating scale.Results The two groups both achieved satisfactory sedative and analgesic effects.The RSS score was maintained at 2~4 points,and the BIS was during 62~75.At T4 and T5 time points,the HR and MAP of the GL group were significantly higher than those of the GS group (P<0.05);at the T1 and T2 time points,the RR and RSS scores of the GL group were significantly lower than those of the GS group (P<0.05);At T2 and T5 time points,the BIS in the GL group was significantly lower than that in the GS group (P<0.05).There were no significant differences in LRR,incidences of respiratory depression,incidences of oxygen supplementation by facial mask and thrusting the jaw,frequencies of body movements,postoperative recovery time,the recall of intraoperative events,postoperative VAS score,and the satisfaction score of patients and surgeons in both groups of patients.Conclusion Procedural sedation and analgesia using dexmedetomidine combined with remifentanil can be effectively and safely used in long-term liposuction,and its incidence of adverse reactions is not significantly different from that of short-term.