摘要
目的比较下肢静脉曲张腔内激光消融闭合术患者应用右美托咪定-瑞芬太尼(dexmedetomidine-remifentanil,DR)与咪达唑仑-瑞芬太尼(midazolam-remifentanil,MR)方案的镇静镇痛效果及安全性。方法将2019年1月~2020年1月90例下肢静脉曲张腔内激光消融闭合术随机分为2组:DR组给予右美托咪定负荷剂量1μg·kg^-1,随后以0.2~0.7μg·kg^-1·h^-1静脉持续泵入;MR组静脉注射咪达唑仑0.02 mg·kg^-1,间隔追加1~2 mg。2组持续输注瑞芬太尼0.02~0.2μg·kg^-1·min^-1。评估2组给药前、给药后手术前、手术开始、手术开始10 min、手术开始30 min、手术结束时的Ramsay镇静评分(RSS)、疼痛数字评分(NRS),监测生命体征、不良反应,调查患者和术者的满意度。结果DR组给药后手术前~手术结束时的RSS评分明显高于MR组(P<0.05),2组NRS评分差异无显著性(P>0.05)。DR组瑞芬太尼用量较小[(2.5±0.6)vs.(4.4±0.5)μg·kg^-1,t=-16.268,P=0.000],呼吸抑制发生率较低(0 vs.6例,P=0.026)。DR组术者满意度评分更高[(3.8±0.5)vs.(3.4±0.9)分,t=2.487,P=0.015],2组患者满意度评分差异无显著性(P>0.05)。结论右美托咪定复合瑞芬太尼可达到更高的镇静深度和良好的疼痛评分,呼吸抑制的发生率更低,手术医生的满意度更高。
Objective To compare the efficacy and safety of dexmedetomidine-remifentanil(DR)with the traditional analgesia and sedation regimen midazolam-remifentanil(MR)during endovenous laser ablation in patients with lower extremity varicosities.Methods A total of ninety patients diagnosed with lower extremity varicosities receiving endovenous laser ablation from January 2019 to January 2020 were randomized divided into two groups.Patients in the DR group received a loading dose of 1μg·kg^-1 dexmedetomidine,followed by a continuous intravenous infusion of 0.2-0.7μg·kg^-1·h^-1 until the end of the operation.Patients in the MR group received 0.02 mg·kg^-1 of midazolam as a bolus with intermittent midazolam boluses(1-2 mg)to achieve the targeted sedation level.During the procedure,patients in both groups were administered with 0.02-0.2μg·kg^-1·min^-1 of remifentanil.Sedation and analgesia were rated using the Ramsay Sedation Scale(RSS)and Numeric Rating Scale(NRS)before drug administration(T1),after drug administration but before procedure(T2),at the beginning of procedure(T3),10 minutes later(T4),30 minutes later(T5),and at the end of procedure(T6).Vital signs,adverse events,surgeon and patient satisfaction were assessed.Results The Ramsay sedation score was significantly higher from T2 to T6 in the DR group as compared with the MR group(P<0.05).The NRS analgesia scores were not significantly different between the two groups(P>0.05).However,the DR group reported significantly fewer cases of respiratory depression(0 vs.6 cases,P=0.026)with a lower dose of remifentanil[(2.5±0.6)vs.(4.4±0.5)μg·kg^-1,t=-16.268,P=0.000]than the MR group during the treatment.The satisfaction levels of patients were similar in both groups,whereas surgeons were more satisfied with the DR group than with the MR group[(3.8±0.5)vs.(3.4±0.9)points,t=2.487,P=0.015].Conclusion The dexmedetomidine-remifentanil regimen provides deeper sedation,good analgesia,less respiratory depression and higher satisfaction scores of surgeons during endovenous laser ablation of lower extremity varicosities.
作者
徐金慧
魏磊
刘纯
黄剑
唐莲
周大勇
周琴
余娜苇
吴峰
Xu Jinhui;Wei Lei;Liu Chun(Department of Anesthesiology,Suzhou Municipal Hospital,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215002,China;不详)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第11期966-971,共6页
Chinese Journal of Minimally Invasive Surgery
基金
江苏省药学会-奥赛康临床药学基金(A201815)
苏州市立医院院级课题(Slyyjy201801)。
