地佐辛联合瑞芬太尼用于阿尔茨海默病患者白内障超声乳化摘除术镇静镇痛的疗效观察
Effect of the dezocine combined with remifentanil in the sedation and analgesia of Alzheimer's disease patients treated with phacoemulsification
-
摘要: 目的:探讨地佐辛联合瑞芬太尼用于阿尔茨海默病患者白内障超声乳化摘除术镇静镇痛的临床疗效。方法:选择行眼科白内障超声乳化摘除术的阿尔茨海默病患者60例,ASAⅠ~Ⅱ级,随机分为地佐辛组(D组)和对照组(R组)各30例。D组静脉滴注瑞芬太尼负荷剂量0.25μg·kg-1·min-1持续2 min,随后调为0.08μg·kg-1·min-1维持,同时静脉注射地佐辛0.04 mg/kg+咪达唑仑0.02~0.06 mg/kg;R组静脉滴注瑞芬太尼负荷剂量0.25μg·kg-1·min-1持续2 min,随后调为0.08μg·kg-1·min-1维持,同时静脉注射咪达唑仑0.02~0.06 mg/kg,根据改良警觉/镇静评分调节咪达唑仑用量及术中瑞芬太尼维持量,保持该评分≤2分,手术结束时停止药物输注。于麻醉诱导前、麻醉诱导后、手术开始时和手术结束时记录患者的平均动脉压、心率、呼吸、血氧饱和度、手术持续时间、患者苏醒时间、瑞芬太尼和咪达唑仑的用量及术中不良反应出现的情况。结果:与R组相比,D组诱导后血氧饱和度及呼吸频率的变化均较小(P<0.05~P<0.01),手术时间与麻醉苏醒时间均明显缩短(P<0.01),咪达唑仑及瑞芬太尼总量均显著减少(P<0.01),呼吸抑制发生率低(P<0.05)。结论:地佐辛联合瑞芬太尼微泵输注用于阿尔茨海默病患者行眼科白内障超声乳化摘除术镇静、镇痛效果确切,是一种安全、有效的麻醉方法。Abstract: Objective:To observe the clinical efficacy of dezocine combined with remifentanil in the sedation and analgesia of Alzheimer's disease patients treated with phacoemulsification.Methods:Sixty Alzheimer's disease patients with grade ASA Ⅰ to Ⅱ treated with phacoemulsification were randomly divided into the dezocine group(30 cases, group D) and control group(30 cases, group R).The group D were treated with 0.25μg·kg-1·min-1 of remifentanil for 2 min by vein, then the dosage of remifentanil was adjusted for 0.08μg·kg-1·min-1, and the patients were additionally injected using 0.04 mg/kg of dezocine combined with 0.02 to 0.06 mg/kg of midazolam by vein.The group R were treated with 0.25μg·kg-1·min-1 of remifentanil for 2 min by wein, then the dosage of remifentanil was adjusted for 0.08μg·kg-1·min-1, and the patients were additionally injected using 0.02 to 0.06 mg/kg of midazolam by vein.The midazolam dosage and intraoperative remifentanil dosage were adjusted to maintain the modified observer assessment of sedation ≤2, which was stopped until the end of operation.The mean arterial pressure, heart rate, respiratory rate, oxyhemoglobin saturation, time of operation duration and patients awakening, dosage of remifentanil and midazolam and intraoperative adverse reaction were recorded before anaesthesia, after anesthesia, at the start of operation and at the end of operation.Results:Compared with the group R, the changes of oxyhemoglobin saturation and respiratory frequency in group D were less after anesthesia(P <0.05 to P<0.01), the time of operation duration and patients awakening in group D were shorter(P<0.01), the dosage of remifentanil and midazolam in group D were less(P<0.01), and the incidence of respiratory depression was lower(P<0.05).Conclusions:The clinical effect of dezocine combined with remifentanil in the sedation and analgesia of Alzheimer's disease patients treated with phacoemulsification is good, which is a safe method of anesthesia.
-
Key words:
- cataract /
- phacoemulsification /
- Alzheimer's disease /
- dezocine /
- remifentanil /
- conscious sedation
-
[1] 张淑琴,肖波. 神经病学[M]. 北京:高等教育出版社,2003:235. [2] 陈芳,陈聪,陈世云,等. 右美托咪啶监护麻醉用于老年痴呆患者白内障手术的护理配合[J]. 海峡药学,2013,25(6):97. [3] 刘孝文,邓晓明,王烨,等. 靶控输注与静脉输注瑞芬太尼复合异丙酚用于局部麻醉患者镇静镇痛术效应的比较[J]. 中华麻醉学杂志,2012,32(5):622. [4] 郑超,顾恩华,王淑珍. 局麻复合咪达唑仑和舒芬太尼在眼科整形手术中的观察[J]. 天津医药,2014,42(3):264. [5] ROBERTS DJ,HAROON B,HALL RI. Sedation for critical ill or injured adults in the intensive care unit:a shifting paradigm[J]. Drugs,2012,72(14):1881. [6] 姚峥,徐静,陈莲华. 瑞芬太尼静脉连续输注在儿童和成人保留自主呼吸的剂量[J]. 上海医学,2012,35(10):833. [7] 陈勇,佘守章,闫炎,等. 腰-硬联合麻醉患者异丙酚不同镇静深度下半数有效的浓度、脑电双频指数和听觉诱发电位指数[J]. 中华麻醉学杂志,2005,25(2):105. [8] 徐志新,王涛,王天海. 靶控输注异丙酚时脑电双频谱指数与皮肤电传导监测患者镇静深度准确性的比较[J]. 中华麻醉学杂志,2011,31(3):321. [9] 彭秀军. 白内障超声乳化术[M]. 北京:人民军医出版社, 1998:10. [10] 庄心良,曾因明,陈伯銮. 现代麻醉学(下册)[M]. 3版. 北京:人民卫生出版社,2004:1441. [11] 张卫,邢娜,阔全程. 不同年龄患者清醒镇静时靶控输注咪达唑仑的效应室浓度和BIS水平[J]. 中华麻醉学杂志,2008,28(1):10. [12] 郭训,李恒,梁秀生. 地佐辛对瑞芬太尼复合七氟醚麻醉患者恢复期躁动的影响[J]. 广东医学,2014,35(9):1411. [13] 汪卫兵,肖敬,檀彧庆. 芬太尼超前镇痛对瑞芬太尼恒速输注麻醉术后躁动的影响[J]. 安徽医学,2012,5(33):529. [14] 裴焕爽,王树青,裴进宽. 氟比洛芬酯注射液消除瑞芬太尼全身麻醉患者术后苏醒期躁动的临床观察[J]. 河北医药, 2009,31(5):566. [15] 刘会凤,夏晓琼,罗宏丽. 氟比洛芬酯预防瑞芬太尼全麻术后躁动的临床观察[J]. 蚌埠医学院学报,2012,37(11):1305. [16] 马志佳,成国荣. 地佐辛联合异丙酚在无痛胃肠镜检查术的应用[J]. 现代消化及介入诊疗,2012,17(4):202. [17] BOUILLON T,BRUHN J,RADU-RADULESCU L,et al. A model of the ventilatory depressant potency of remifentanil in thenon-steady state[J]. Anesthesiology,2003,99(4):779. [18] FISCHER BD,DYKSTRA LA. Interactions between an N-methly-D-asparte antagonist and low-efficacy opioid receptor agonistsin assays of schedule-controlled responding and thermalnociception[J]. J Pharmacol Exp Ther,2006,318(7):1300. -
点击查看大图
计量
- 文章访问数: 2677
- HTML全文浏览量: 429
- PDF下载量: 103
- 被引次数: 0
下载:
