右美托咪定清醒镇静对帕金森病患者脑深部电刺激植入术喉罩全麻的影响

发布时间：2018-02-26 05:06

本文关键词： 右美托咪定清醒镇静帕金森病脑深部电刺激植入术喉罩全麻　出处：《临床麻醉学杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的探讨右美托咪定清醒镇静对帕金森病(Parkinson’s Disease,PD)患者脑深部电刺激植入术(deep brain electric stimulus implantation,DBS)喉罩全麻的影响。方法选择择期行双侧丘脑底核DBS的PD患者40例,男32例,女8例,年龄18~75岁,ASAⅠ或Ⅱ级。随机将患者分为右美托咪定组(D组)和对照组(C组),每组20例。手术分两阶段进行:第一阶段在局麻下放置电极,CT检查证实电极放置满意为第一阶段结束;第二阶段需在全麻下埋置脉冲发生器于胸前皮下。D组在入室后15 min内经静脉匀速泵入负荷剂量右美托咪定0.5μg/kg,继之以0.1~0.3μg·kg-1·h-1持续泵注至手术第一阶段结束;C组泵入同等剂量生理盐水。记录微电极受干扰和震颤减轻次数;记录患者入室时(T0)、局部浸润麻醉时(T1)、一侧电极植入时(T2)、对侧电极植入时(T3)、第一阶段结束时(T4)的Ramsay镇静评分;记录意识消失时间、喉罩置入时间、自主呼吸恢复时间和拔管时间;记录全麻开始至手术结束丙泊酚、瑞芬太尼总用量。结果两组患者微电级受干扰、震颤减轻发生率差异无统计学意义;D组T1~T4时的Ramsay评分明显高于C组(P0.05),意识消失时间、喉罩置入时间、自主呼吸恢复时间和拔管时间明显短于C组(P0.05),全麻开始至手术结束丙泊酚、瑞芬太尼总用量明显少于C组(P0.05)。结论右美托咪定可为帕金森病脑深部电刺激植入术第一阶段提供良好镇静;并能缩短第二阶段喉罩全麻诱导及苏醒时间,减少丙泊酚、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.
【作者单位】：重庆医科大学附属永川医院麻醉科;复旦大学附属华山医院麻醉科;复旦大学附属华山医院神经外科;
【分类号】：R614

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