右旋美托咪啶在眼科手术中的应用(1)
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【摘要】 目的 探讨右旋美托咪啶(Dexmedetomidine，Dex)在玻璃体手术中应用。方法 选择择期行玻璃体手术患者60例，随机分入异丙酚联合舒芬太尼监测麻醉(monitored anesthesia care,MAC)(Group P)和右旋美托咪啶MAC组(Group D)。每组30例，两组患者均行球周阻滞麻醉，并连接双频谱指数(Bispect ral index，BIS)监测仪，监测并维持BIS值在70~80间，观察平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、呼吸频率(Respiratory rate，RR)、Ramsay镇静评分、视觉模拟法(visual analogue scale VAS)疼痛评分及术中眼心反射和术后恶心呕吐等不良反应。结果与麻醉前比较，P组中除了术后1 h的MAP、HR、镇静评分无统计学意义外,其余时间点MAP、HR、镇静评分、疼痛评
分差异有统计学意义(P<0.05)，而D组中的MAP、HR、镇静评分、疼痛评分在各个时间点差异有统计学意义(P<0.05)；两组比较，在术后1 h时间点,D组MAP、HR较P组差异有统计学意义(P<0.05)；在术后1 h时间点,D组的镇静评分较P组有显著意义的升高(P<0.05)。两组患者术中、术后各种不良反应中，D组患者术中躁动和低氧血症的发生率较P组患者差异有统计学意义(P<0.05)；术后的恶心发生率差异有统计学意义(P<0.05)。结论 右旋美托咪啶用于玻璃体视网膜手术，镇静效果好，镇痛完善，不良反应少，但术后镇静时间较长。
【关键词】 右旋美托咪啶;镇静;镇痛;玻璃体手术
【Abstract】 Objective To investigate efficacy,safety and feasibility of Dexmedetomidine in vitreous surgery.Methods Sixty patients undegoing vitreous surgery under peribulbar anaesthesia were randomly divided into Dexmedetomidine group(Group D)and Propofol combined with Sufentanyl group(Group D)each with 30 cases.The patients were monitored with Bispectral index(BIS)and keep BIS between 7080,sedation was titrated to a Ramsay sedation score of 3.Mean arterial Pressure(MAP)、Heart rate(HR)、Respiratory rate(RR)during the investigation were obtained.The visual analogue scale VAS and amsay sedation score were evaluated.Intraoperative reactions such as oculocardiac reflex,hypoxemia,restlessness,nausea and vomiting groaning were assessed.Results Compared with preanaesthesia,there was significant difference in MAP,HR,Rasmay sedation score and VAS score(P<0.05)of group P in all the time points except for 1 h post sugery.There was significant difference in MAP,HR,RASMAY sedation score and VAS score between group D and group P(P<0.05).1 h post sugery,MAP and HR were lower in group D compared with that of group P(P<0.05),while Rasmay sedation score was higher in group D compared with that of group P(P<0.05).The incidence of intraoperative restlessness and hypoxemia,as well as postoperative nausea in group D were significantly lower than that of group P(P<0.05).Conclusion Application of Dexmedetomidine in vitreous surgery was effect in sedative,consummate in analgesia,less adverse reactions,while maintain longer duration of sedation.
【Key words】 Dexmedetomidine; Sedation; Analgesic; Vitreous surgery
眼科玻璃体手术因难度大、时间长、操作精细，要求镇痛完全、患者充分安静、合作[1] ......
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