在整形外科手术镇静镇痛中两种不同给药模式下使用右美托咪定的疗效与安全性比较。

Comparison of the Efficacy and Safety of Dexmedetomidine Administered in Two Different Modes Under Procedural Sedation and Analgesia in Plastic Surgery.

作者信息

Xia Weipeng, Wang Shanshan, Wei Lingxin, Deng Xiaoming, Yang Dong, Sui Jinghu, Liu Juhui

机构信息

Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.

Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

出版信息

Front Surg. 2022 May 2;9:836398. doi: 10.3389/fsurg.2022.836398. eCollection 2022.

DOI:10.3389/fsurg.2022.836398

PMID:35586507

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9108426/

Abstract

BACKGROUND

Dexmedetomidine (DEX), a highly selective α2-adrenergic receptor agonist, is now widely used in procedural sedation and analgesia. This study was designed to observe and compare the efficacy and safety of DEX administered in two different modes.

METHODS

In total, 100 patients were randomly divided into two groups to receive intravenous DEX 1 µg/kg over 15 min followed by 0.4-0.7 µg/kg/h infusion or DEX 1 µg/kg over 30 min followed by 0.4-0.7 µg/kg/h infusion. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), bispectral index (BIS), Ramsay Sedation Scores (RSS scores), the lowest respiratory rates (LRR), incidences of respiratory adverse events and frequencies of body movements were recorded. Recovery time, recall of intraoperative events, pain scores in PACU and satisfaction of patients and surgeons were assessed.

RESULTS

The BIS at time points from 5 min after anesthesia to the end of surgery in the intervention group were significantly higher ( < 0.05). The RSS scores at time points from 5 min after anesthesia to immediately after induction with DEX were significantly higher in the intervention group ( < 0.05). The HR at time points from the beginning of surgery to 30 min after local anesthesia, the MAP at time points from 30 min after local anesthesia to the end of surgery, and the RR at time points from 5 min after anesthesia to the end of surgery were significantly higher in the intervention group ( < 0.05). Patients in the intervention group had higher LRR, lower incidences of respiratory adverse events, and shorter recovery time ( < 0.05).

CONCLUSIONS

Dexmedetomidine infused with a loading dose over 30 min had less impact on patients' hemodynamics and respiration and could shorten the recovery time after anesthesia in procedural sedation and analgesia.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, identifier: ChiCTR1900027958.

摘要

背景

右美托咪定（DEX）是一种高选择性α2肾上腺素能受体激动剂，目前广泛用于程序性镇静和镇痛。本研究旨在观察和比较两种不同给药方式下DEX的疗效和安全性。

方法

总共100例患者被随机分为两组，一组在15分钟内静脉输注DEX 1μg/kg，随后以0.4 - 0.7μg/kg/h的速度输注；另一组在30分钟内静脉输注DEX 1μg/kg，随后以0.4 - 0.7μg/kg/h的速度输注。记录心率（HR）、平均动脉压（MAP）、呼吸频率（RR）、脑电双频指数（BIS）、 Ramsay镇静评分（RSS评分）、最低呼吸频率（LRR）、呼吸不良事件发生率和身体活动频率。评估恢复时间、术中事件回忆、PACU中的疼痛评分以及患者和外科医生的满意度。

结果

干预组从麻醉后5分钟至手术结束各时间点的BIS显著更高（P<0.05）。干预组从麻醉后5分钟至DEX诱导后即刻各时间点的RSS评分显著更高（P<0.05）。干预组从手术开始至局部麻醉后30分钟各时间点的HR、从局部麻醉后30分钟至手术结束各时间点的MAP以及从麻醉后5分钟至手术结束各时间点的RR显著更高（P<0.05）。干预组患者的LRR更高，呼吸不良事件发生率更低，恢复时间更短（P<0.05）。