右美托咪定复合瑞芬太尼在睑袋整复术中的应用

吴明浩，李翔，陈惠裕.右美托咪定复合瑞芬太尼在睑袋整复术中的应用[J].中华整形外科杂志.2014, 30(3):183-186

右美托咪定;瑞芬太尼;下睑袋整复术

吴明浩，李翔，陈惠裕

210011,南京医科大学第二附属医院麻醉科

2014年

183-186

知网,万方

目的 探讨右美托咪定复合瑞芬太尼用于睑袋整复术中可唤醒麻醉的可行性和安全性.方法 选择2010年10月至2013年3月门诊收治的50例ASA分级Ⅰ～Ⅱ级睑袋整复术患者,按随机数字表法将患者随机分为观察组和对照组2组,各25例.采用双盲法,观察组患者将右美托咪定0.8 μg/kg用输液泵10 min内泵入,然后持续静脉输注右美托咪定0.3μg·kg-1 ·h-1+瑞芬太尼0.05 μg· kg-·min 1,对照组采用1％利多卡因2 ml加1∶20万的肾上腺素局部浸润麻醉+咪达唑仑0.04 mg/kg镇静.观察2组患者术中生命体征变化,患者术中躁动和配合情况,以及术者和患者的满意度.记录手术时间、术后苏醒时间、术中术后不良反应的发生率及术中药物干预情况.结果 观察组和对照组的手术时间分别为(56.4±7.2)min和(55.6±6.8)min,苏醒时间分别为(3.0±0.23) min和(2.1±0.34) min,两者比较差异无统计学意义(P＞0.05);与对照组心率(78.2±7.6)次/min相比,观察组心率(64.2±8.2)次/min,下降明显(P＜0.05),无明显呼吸抑制(SpO2＜90％、RR ＜8次/min).观察组除有1例患者需加深麻醉外,其余24例术中均无躁动并配合术者完成手术.对照组有4例患者术中无躁动,有18例术中躁动但能配合完成手术,3例需辅助静脉药物.观察组术者和患者的满意度(96％)均明显高于对照组(24％,P ＜0.05).结论 右美托咪定复合瑞芬太尼可安全地应用于患者睑袋整复术,但应注意右美托咪定的减慢心率作用. Objective To explore the feasibility and safety of dexmedetomidine combined with remifentanil for lower eyelid blepharoplasty.Methods 50 paticnts undergoing lower eyelid blepharoplasty ASA Ⅰ ～ Ⅱ were randomly divided into 2 groups(25 in each group)as observation group and control group.Dexmedetomidine (0.3 μg· kg-1 · h-1) and remifentanil (0.05 μg· kg-1 · min-1) were used in observation group.Local anesthesia by lidocaine (1％)combined with midazo]am (0.04 mg/kg) intravenous sedation were used in control group.HR、mean arterial pressure (MAP),heart rate (HR),breathing rate (RR),pulse oxygen saturation (SpO2) change were monitored and recorded before and after the administration of the drug,as well as at the beginning of operation,during the operation,at the end of the operation,and 5 minutes after the operation.Patients sedation degree was evaluated by Ramsay.Operation time,recovery time,the incidence of adverse reactions,the satisfaction of patients and doctors were also recorded.Results Patients had no obvious difference of intraoperative MAP、RR、SpO2 、operation time and postoperative recovery time between the two groups (P ＞ 0.05).Compared with control group,HR during the operation were decreased significantly [(64.2 ± 8.2) bprn,P ＜ 0.05] in observation group.In control group,there were 18 cases of patients with agitation,but they endured the operation anyway.In observation group,24 cases of patients underwent operation without agitation.The satisfaction of patients and the operation doctors (96％) in observation group were markedly higher than that in control group(P ＜0.05).Conclusion Dexmedetomidine combined with remifentanil is practical and safe.The effcct of reducing HR should be noticed.。