本文關(guān)鍵詞： 右美托咪定 清醒鎮(zhèn)靜 帕金森病 腦深部電刺激植入術(shù) 喉罩全麻　出處：《臨床麻醉學(xué)雜志》2017年05期 　論文類型：期刊論文

【摘要】：目的探討右美托咪定清醒鎮(zhèn)靜對帕金森病(Parkinson’s Disease,PD)患者腦深部電刺激植入術(shù)(deep brain electric stimulus implantation,DBS)喉罩全麻的影響。方法選擇擇期行雙側(cè)丘腦底核DBS的PD患者40例,男32例,女8例,年齡18~75歲,ASAⅠ或Ⅱ級(jí)。隨機(jī)將患者分為右美托咪定組(D組)和對照組(C組),每組20例。手術(shù)分兩階段進(jìn)行:第一階段在局麻下放置電極,CT檢查證實(shí)電極放置滿意為第一階段結(jié)束;第二階段需在全麻下埋置脈沖發(fā)生器于胸前皮下。D組在入室后15 min內(nèi)經(jīng)靜脈勻速泵入負(fù)荷劑量右美托咪定0.5μg/kg,繼之以0.1~0.3μg·kg-1·h-1持續(xù)泵注至手術(shù)第一階段結(jié)束;C組泵入同等劑量生理鹽水。記錄微電極受干擾和震顫減輕次數(shù);記錄患者入室時(shí)(T0)、局部浸潤麻醉時(shí)(T1)、一側(cè)電極植入時(shí)(T2)、對側(cè)電極植入時(shí)(T3)、第一階段結(jié)束時(shí)(T4)的Ramsay鎮(zhèn)靜評(píng)分;記錄意識(shí)消失時(shí)間、喉罩置入時(shí)間、自主呼吸恢復(fù)時(shí)間和拔管時(shí)間;記錄全麻開始至手術(shù)結(jié)束丙泊酚、瑞芬太尼總用量。結(jié)果兩組患者微電級(jí)受干擾、震顫減輕發(fā)生率差異無統(tǒng)計(jì)學(xué)意義;D組T1~T4時(shí)的Ramsay評(píng)分明顯高于C組(P0.05),意識(shí)消失時(shí)間、喉罩置入時(shí)間、自主呼吸恢復(fù)時(shí)間和拔管時(shí)間明顯短于C組(P0.05),全麻開始至手術(shù)結(jié)束丙泊酚、瑞芬太尼總用量明顯少于C組(P0.05)。結(jié)論右美托咪定可為帕金森病腦深部電刺激植入術(shù)第一階段提供良好鎮(zhèn)靜;并能縮短第二階段喉罩全麻誘導(dǎo)及蘇醒時(shí)間,減少丙泊酚、瑞芬太尼用量。
[Abstract]:Objective to investigate the effect of dexmetomidine sober sedation on laryngeal mask anesthesia in patients with Parkinson's disease (PD) undergoing deep brain electric stimulus implantation.Methods 40 PD patients with bilateral subthalamic nucleus DBS, 32 males and 8 females, were selected. The patients were randomly divided into dexmetomidine group (group D) and control group (group C, n = 20). The operation was carried out in two stages: the first stage was the placement of electrodes under local anesthesia and CT examination confirmed satisfactory placement of the electrodes. For the end of the first phase; In the second stage, the pulse generator should be implanted under general anesthesia at the dose of 0.5 渭 g / kg of dexmetomidine within 15 min after entering the room, followed by 0.1 渭 g 路kg-1 路h-1 continuous pump of 0.1 渭 g 路kg-1 路h-1 until the end of the first stage of operation. Group C was pumped into the same level at the end of the first stage of operation. Dose of normal saline. The number of interference and tremor reduction of microelectrode was recorded. The Ramsay sedation scores were recorded at the time of entering the room, during local infiltration anesthesia, when one side electrode was implanted, when the contralateral electrode was implanted, and at the end of the first stage. The time of consciousness disappearance, the time of laryngeal mask placement, the time of spontaneous respiratory recovery and the time of extubation were recorded. Results the Ramsay score of group D was significantly higher than that of group C (P 0.05) and the time of consciousness disappearance was not significantly higher than that of group C at T1 and T4, results the microelectric grade of the two groups was disturbed and the incidence of tremor abated was not significantly different from that of group D to that of group C, the total dosage of remifentanil and propofol from the beginning of general anesthesia to the end of operation. The time of laryngeal mask placement, spontaneous respiratory recovery and extubation were significantly shorter than those in group C (P 0.05), and propofol from the beginning of general anesthesia to the end of operation. The total dosage of remifentanil was significantly less than that of group C (P 0.05). Conclusion dexmetomidine can provide good sedation for the first stage of deep brain electrical stimulation implantation for Parkinson's disease, shorten the induction and recovery time of laryngeal mask anesthesia in the second stage, and reduce propofol. Remifentanil dosage.
【作者單位】： 重慶醫(yī)科大學(xué)附屬永川醫(yī)院麻醉科;復(fù)旦大學(xué)附屬華山醫(yī)院麻醉科;復(fù)旦大學(xué)附屬華山醫(yī)院神經(jīng)外科;
【分類號(hào)】：R614

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