[1]徐金慧① 魏磊** 刘纯① 黄剑② 唐莲① 周大勇**② 周琴① 余娜苇③ 吴峰④.右美托咪定与咪达唑仑用于静脉曲张激光消融术中清醒镇静的比较：前瞻性随机对照研究[J].中国微创外科杂志,2020,01(11):966-971.
　Xu Jinhui,Wei Lei*,Liu Chun,et al.Comparison of Analgesic and Sedative Effects of Dexmedetomidine and Midazolam During Endovenous Laser Ablation of Lower Extremity Varicosities: a Prospective Randomized Controlled Study[J].Chinese Journal of Minimally Invasive Surgery,2020,01(11):966-971.
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右美托咪定与咪达唑仑用于静脉曲张激光消融术中清醒镇静的比较：前瞻性随机对照研究()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年11期
页码:
966-971
栏目:
临床论著
出版日期:
2020-11-25

文章信息/Info

Title:
Comparison of Analgesic and Sedative Effects of Dexmedetomidine and Midazolam During Endovenous Laser Ablation of Lower Extremity Varicosities: a Prospective Randomized Controlled Study
作者:
徐金慧① 魏磊** 刘纯① 黄剑② 唐莲① 周大勇**② 周琴① 余娜苇③ 吴峰④
(苏州市立医院南京医科大学附属苏州医院麻醉科，苏州215002)
Author(s):
Xu Jinhui;  Wei Lei*;  Liu Chun;  et al.
*Department of Anesthesiology, Suzhou Municipal Hospital, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou 215002, China
关键词:
右美托咪定; 咪达唑仑; 瑞芬太尼; 下肢静脉曲张; 腔内激光消融闭合术
Keywords:
Dexmedetomidine; Midazolam; Remifentanil; Lower extremity varicosities; Endovenous laser ablation
文献标志码:
A
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1 μg·kg-1，随后以0.2~0.7 μg·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2 μg·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。
Abstract:
ObjectiveTo 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.MethodsA 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 1 μg·kg-1 dexmedetomidine, followed by a continuous intravenous infusion of 0.2-0.7 μg·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 0.02-0.2 μg·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.ResultsThe 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］.ConclusionThe 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.

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备注/Memo

备注/Memo:
基金项目：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)**通讯作者，Email：64624369@qq.com(魏磊)；zhoucliz@163.com(周大勇)①(苏州市立医院南京医科大学附属苏州医院药学部，苏州215002)②(苏州市立医院南京医科大学附属苏州医院血管外科，苏州215002)③(徐州医科大学，徐州221004)④(南京医科大学，南京211166)
更新日期/Last Update: 2021-02-07