咪达唑仑与右美托咪定对乳腺外科手术患者麻醉效果、微循环与应激水平影响

Effect of Midazolam and Dexmedetomidine on Anesthesia,Microcirculation and Stress Levels in Patients Undergoing Breast Surgery

目的:对比咪达唑仑、右美托咪定在乳腺手术中辅助麻醉的效果及安全性情况。方法:选取2021年1月—2022年4月开封市妇产医院收治的90例乳腺癌患者作为研究对象,经抽签法将其随机分为A组(45例,术中采用咪达唑仑麻醉)和B组(45例,术中采用右美托咪定麻醉),比较两组患者麻醉效果及麻醉安全性。结果:(1)苏醒质量:术后,B组的视觉模拟疼痛(VAS)评分、Ramsay评分(RASS)低于A组,警觉/镇静观察评分(OAA/S)评分高于A组,差异有统计学意义(t=13.253、10.388、31.405,P<0.05);(2)微循环功能:术后,B组的血氧饱和度(SPO_(2))、动脉氧分压(PaO_(2))高于A组,平均动脉压(MAP)、动脉二氧化碳分压(PaCO_(2))低于B组,差异有统计学意义(t=48.772、4.980、6.814、2.889,P<0.05);(3)氧化应激情况:术后,B组的超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)高于B组,丙二醛(MDA)低于A组,差异有统计学意义(t=8.311、18.337、34.853、4.223,P<0.05);(4)麻醉安全性:术后,B组的不良事件发生率11.11%(5/45)略低于A组15.56%(7/45),差异无统计学意义(χ^(2)=0.857,P>0.05)。结论:咪达唑仑、右美托咪定对乳腺外科手术患者的麻醉安全性高,但相比之下,右美托咪定麻醉后患者的苏醒质量更好、术后微循环功能障碍及氧化应激反应的发生风险更低,更具临床应用价值。

Objective:To compare the effectiveness and safety of midazolam and dexmedetomidine as an adjunct to anesthesia in breast surgery.Methods:90 breast cancer patients admitted to the hospital from January 2021 to April 2022 were selected and randomly divided into group A(45 patients with intraoperative midazolam anesthesia)and group B(45 patients with intraoperative dexmedetomidine anesthesia)by lottery method.The anesthetic effect and anesthetic safety were compared between the two groups.Results:(1)Quality of recovery:Postoperatively,the visual analogue pain(VAS)score and Ramsay score(RASS)in group B were lower than those in group A,and the observation of alertness/sedation score(OAA/S)score was higher than that in group A,and the difference was statistically significant(t=13.253,10.388,31.405,P<0.05).(2)Microcirculatory function:After surgery,the oxygen saturation(SPO_(2))and arterial partial pressure of oxygen(PaO_(2))in group B were higher than those in group A,and the mean arterial pressure(MAP)and arterial partial pressure of carbon dioxide(PaCO_(2))were lower than those in group B,and the differences were statistically significant(t=48.772,4.980,6.814,2.889,P<0.05).(3)Oxidative stress:Postoperatively,superoxide dismutase(SOD),catalase(CAT),and glutathione peroxidase(GSH-Px)were higher in group B than in group B,and malondialdehyde(MDA)was lower than in group A,and the differences were statistically significant(t=8.311,18.337,34.853,4.223,P<0.05).(4)Safety of anesthesia:After surgery,the incidence of adverse events in group B was 11.11%(5/45),which was slightly lower than 15.56%(7/45)of group A,and the difference was not statistically significant(χ^(2)=0.857,P>0.05).Conclusion:Midazolam and dexmedetomidine are safe for anesthesia in patients undergoing breast surgery,but in comparison,dexmedetomidine has better quality of awakening,lower risk of postoperative microcirculatory dysfunction and oxidative stress after anesthesia,and is more valuable for clinical application.