右美托咪定复合丙泊酚用于无痛人流术的临床效果

目的探讨右美托咪定复合丙泊酚用于无痛人流术的麻醉效果。方法随机将50例自愿要求人工流产的妇女分为2组,分别用右美托咪定复合丙泊酚和芬太尼复合丙泊酚麻醉。观察2组注药前(T0)、注药后2 min(T1)、扩阴器置入时(T2)、扩宫颈时(T3)及苏醒时(T4)的HR、RR、SBP、SpO2的变化,以及麻醉起效时间、苏醒时间和离院时间。术毕进行麻醉效果分级,并记录麻醉后不良反应发生情况。结果 D组镇痛效果优于F组(P<0.05)。T1时2组HR、SBP及SpO2明显低于T0时(P<0.05)。T2～T4时D组HR、SBP低于F组和T0时(P<0.05)。F组起效、苏醒和离院时间长于D组(P<0.05),F组丙泊酚用量明显高于D组(P<0.05)。术中舌后坠和呼吸抑制F组明显高于D组(P<0.05),F组苏醒时头晕、躁动发生率明显高于D组(P<0.05)。结论右美托咪定复合丙泊酚可以安全用于无痛人流术且麻醉效果满意。     

右美托咪定复合丙泊酚用于无痛纤维结肠镜检查术的效果

目的观察右美托咪定复合丙泊酚用于无痛纤维结肠镜检查术的麻醉效果及安全性。方法 50例ASAⅠ或Ⅱ级行纤维结肠镜检查术患者,随机分为右美托咪定复合丙泊酚组(D组)和丙泊酚组(P组),每组25例。D组10 min内缓慢静脉注射右美托咪定1μg/kg,再静脉注射丙泊酚2mg/kg;P组单独静脉注射丙泊酚2.5 mg/kg,必要时追加丙泊酚。对两组患者的麻醉镇痛效果进行评级;观察两组患者注药前(T0)、注药后2 min(T1)、过脾曲时(T2)、过肝曲时(T3)及苏醒时(T4)HR、RR、SBP、SpO2的变化;以及麻醉起效时间、苏醒时间和离院时间;麻醉后不良反应发生情况。结果 D组镇痛效果优于P组(P<0.05)。T1时两组HR慢于、SBP及SpO2均明显低于T0时(P<0.05)。T2~T4时D组HR慢于、SBP低于P组和T0时(P<0.05)。P组起效、苏醒和离院时间长于D组(P<0.05),P组丙泊酚用量明显高于D组(P<0.05)。术中舌后坠和呼吸抑制P组明显高于D组(P<0.05),P组苏醒时头晕、躁动发生率明显高于D组(P<0.05)。结论右美托咪定复合丙泊酚可以安全用于无痛纤维结肠镜检查且麻醉效果满意...     

小剂量右美托咪定复合丙泊酚在无痛小肠镜诊疗术中的应用

目的 观察小剂量右美托咪定复合丙泊酚在无痛小肠镜诊疗术中应用的安全性和有效性.方法 50例行无痛小肠镜检查的患者,ASAⅠ～Ⅲ级,年龄32～76岁,体重48～73 kg.随机均分为右美托咪定复合丙泊酚麻醉组(D组)、丙泊酚麻醉组(P组).记录给药前(T0)、给药后5min (T1)、10 min (T2)、15 min (T3)、20 min(T4)、30 min (T5)时的HR、MAP、RR、SpO2;记录手术时间、苏醒时间、丙泊酚总用量、不良反应发生率及患者满意度.结果 所有病例均能顺利完成操作,T1～T5时D组HR慢于T0时和P组(P＜0.05);T1、T2时P组MAP高于T0时和D组(P＜0.05),两组RR、SpO2、手术时间、苏醒时间差异无统计学意义;D组丙泊酚总用量、不良反应发生率均明显低于P组(P＜0.05),两组患者满意度差异无统计学意义.结论 静脉注射小剂量右美托咪定能产生一定的镇静作用,麻醉中可节省丙泊酚的用量,并具有良好的安全性.     

右美托咪定复合丙泊酚与瑞芬太尼对脑动脉瘤夹闭术的麻醉效果

目的观察右美托咪定复合丙泊酚与瑞芬太尼对脑动脉瘤夹闭术患者的麻醉效果。方法选取64例脑动脉瘤夹闭术患者,按照麻醉方法不同分为2组,各32例。观察组麻醉诱导前给予右美托咪定1.0μg/kg,并以0.4μg/(kg·h)右美托咪定维持至拔除气管导管。对照组给予等容量0.9%的氯化钠注射液。2组均采用丙泊酚、瑞芬太尼与罗库溴铵进行麻醉诱导,对比2组麻醉效果。结果观察组T_1、T_2、T_3时点的HR、DBP、SBP低于对照组,不良反应发生率低于对照组,差异具有统计学意义(P0.05)。结论右美托咪定复合丙泊酚与瑞芬太尼对脑动脉瘤夹闭术患者血流动力学影响较小,具有较高的安全性和应用价值。     

右美托咪定复合丙泊酚用于肩周炎松解术的效果

目的探讨右美托咪啶（dexmedetomidin）复合丙泊酚用于肩周炎松解术的临床效果。方法将60例晚期肩周炎行肩关节松解术的患者随机分为2组：右美托咪定复合丙泊酚组（D组）和芬太尼复合丙泊酚组（F组）观察2组给药前、松解术中HR和MAP,并术中躁动的发生率和躁动程度,术后进行VAS评分。结果 F组和D组躁动的发生率分别为33.3%和10.0%,与F组比较,D组躁动发生率降低（P〈0.05）。术中F组HR明显快于D组、F组MAP明显高于D组;术后4 h、12 h时VAS评分F组明显高于D组。结论右美托咪啶复合丙泊酚用于肩周炎松解术优于芬太尼复合丙泊酚,可提高麻醉镇痛的效果且减少术后疼痛的发生。     

右美托咪定与丙泊酚用于小儿腹股沟疝手术麻醉的比较

目的比较静脉输注右美托咪定与丙泊酚在小儿腹股沟疝手术患者中的镇静效果和安全性。方法选择ASAⅠ或Ⅱ级择期行单侧腹股沟疝修补术的男性患儿40例,所有患儿入室后给予丙泊酚2mg·kg-1,面罩吸氧。右美托咪定组(A组)患儿静脉输注右美托咪定负荷剂量1μg·kg-1(给药时间大于15分钟)及1μg.kg-1·h-1的维持量。丙泊酚组(B组)静脉输注丙泊酚负荷量1.5mg·kg-1,随后以3mg.kg-1·h-1的速度连续输注。术中给予多功能脑电监测仪(BIS)了解镇静深度。记录麻醉诱导前(T1)、麻醉药物负荷量给药后(T2)、切皮时(T3)、苏醒时(T4)心率,平均动脉压,呼吸频率,心电图和脉搏血氧饱和度,同时记录手术和麻醉相关并发症。结果两组患儿在T2、T3时心率较T1时显著降低,A组患儿在T4时心率增高的程度低于B组,(P<0.05),各时点数值均在正常范围内。呼吸抑制例数A组较B组少。结论右美托咪定在儿科患者中的镇静治疗是有效且安全的。     

右美托咪定与丙泊酚麻醉诱导时的协同作用

目的评价右美托咪定和丙泊酚麻醉诱导时镇静作用的相互影响。方法择期全麻手术患者75例,男36例,女39例,年龄18～65岁,BMI 20～25kg/m~2,ASAⅠ或Ⅱ级,采用随机数字表法均分为三组,每组25例:丙泊酚组(A组)、右美托咪定组(B组)、丙泊酚复合右美托咪定组(C组),每组再根据不同药物剂量分为5个亚组,相邻两组剂量等比为1.25,采用点斜法计算ED_(50)及其95%可信区间(CI)。结果A组丙泊酚诱导剂量ED_(50)为1.25 mg/kg(95%CI 0.90～1.45mg/kg),B组右美托咪定麻醉诱导剂量ED_(50)为1.35μg/kg(95%CI 0.95～1.50μg/kg),C组丙泊酚和右美托咪定诱导剂量ED_(50)分别为0.65mg/kg(95%CI 0.50～0.90mg/kg)和0.40μg/kg(95%CI 0.34～0.65μg/kg)。等辐射分析法判定丙泊酚和右美托咪定之间在镇静效应上呈现协同作用。结论右美托咪定复合丙泊酚可以产生明显的镇静效应协同作用。     

右美托咪定用于丙泊酚麻醉下改良电休克治疗的研究进展

改良电休克治疗（modified electroconvulsive therapy, MECT）是目前临床上用于治疗严重精神疾病的有效物理方法。右美托咪定（dexmedetomidine, Dex）是一种亲脂性的α羟甲基衍生物,具有镇静、止痛和阻滞交感神经的作用,易于唤醒,利于稳定循环,近年来Dex也开始用于MECT...     

右美托咪定复合氯胺酮用于患儿经皮肾穿刺活检术的效果

目的探讨右美托咪定复合氯胺酮用于患儿经皮肾穿刺活检术的效果。方法选择拟行经皮肾穿刺活检术的患儿60例,男32例,女28例,年龄1～12岁,体重9～36 kg,ASAⅡ或Ⅲ级。采用随机数字表法随机分为两组:右美托咪定复合氯胺酮组(DK组)和丙泊酚复合氯胺酮组(PK组),每组30例。入室后DK组先予右美托咪定1μg/kg负荷量,10 min泵完,后予氯胺酮1 mg/kg静注诱导,右美托咪定0.5μg·kg~(-1)·h~(-1)泵注维持;PK组缓慢静注丙泊酚中长链脂肪乳2～2.5 mg/kg、氯胺酮1 mg/kg诱导,丙泊酚中长链脂肪乳6 mg·kg~(-1)·h~(-1)泵注维持。术中出现体动反应时静脉追加氯胺酮0.5 mg/kg。观察并记录两组术中体动反应、氧饱和度下降(SpO_295%)的发生情况,记录追加氯胺酮情况、术后苏醒时间和苏醒期躁动的发生情况。结果 DK组术中体动反应和SpO_2下降发生率明显低于PK组(P0.05)。DK组追加氯胺酮比例明显少于PK组(P0.05),苏醒时间明显长于PK组(P0.05),苏醒期躁动发生率明显低于PK组(P0.05)。结论右美托咪定复合氯胺酮全麻用于患儿经皮肾穿刺活检术,可有效降低患儿术中体动反应和SpO_2下降发生率,降低追加氯胺酮比例,减少苏醒期躁动,但延长了苏醒时间。     

右美托咪定联合丙泊酚在面部整形手术患者中的麻醉效果

目的 探讨在面部整形手术中采用不同的麻醉方案所取得的效果。方法 选取2022年1月-2023年 3月于我院接受面部整形手术的150例患者作为研究对象,按治疗先后顺序分为对照组和试验组,各75例。 对照组采用丙泊酚联合舒芬太尼麻醉,试验组采用右美托咪定联合丙泊酚麻醉,比较两组不同时间段的生 命体征、并发症发生情况、手术过程中的舒芬太尼追加情况、麻醉效果、苏醒指标。结果 试验组收缩压 与舒张压波动幅度小于对照组,差异有统计学意义（P＜0.05）;试验组并发症发生率为1.33%,低于 对照组的10.67%,差异有统计学意义（P＜0.05）;试验组舒芬太尼追加剂量为（3.02±0.23）μg,低 于对照组的（4.25±1.35）μg,差异有统计学意义（P＜0.05）;试验组VAS评分及Ramsay评分均低于 对照组,差异有统计学意义（P＜0.05）;试验组术后苏醒时间及清醒时间均短于对照组,差异有统计 学意义（P＜0.05）。结论 面部整形手术中应用右美托咪定联合丙泊酚方案进行麻醉,能够获得更有效的 麻醉效果,患者疼痛程度较轻,且患者相关体征平稳,术后苏醒时间以及清醒时间均较短。     

羟考酮复合丙泊酚在无痛取卵术中的应用

目的观察羟考酮复合丙泊酚用于无痛取卵术的镇痛效果及安全性。方法选择我院门诊行无痛取卵术患者100例,年龄20~40岁,体重45~75kg,ASAⅠ或Ⅱ级,按随机数字表法分为两组:羟考酮复合丙泊酚组(A组)和单纯丙泊酚组(B组),每组50例。A组缓慢静脉注射羟考酮0.1mg/kg(生理盐水稀释至5ml),B组静脉注射等量生理盐水,5min后均静脉注射丙泊酚1.5~2mg/kg。苏醒时间、手术操作时间、丙泊酚用量、术后30min VAS评分和不良反应发生情况。结果术中丙泊酚用量A组为(121±18)mg,明显少于B组的(165±21)mg(P0.05)。术后VAS评分A组为(1.5±0.8)分,明显低于B组的(3.2±0.7)分(P0.05)。体动反应A组有8例(16%),明显少于B组的30例(60%)(P0.05)。结论羟考酮复合丙泊酚可安全用于无痛取卵术并能减少丙泊酚用量,减轻术后疼痛。     

Determination of the pharmacodynamic interaction of propofol and dexmedetomidine during esophagogastroduodenoscopy in children

Objectives: Propofol is a sedative‐hypnotic drug commonly used to anesthetize children undergoing esophagogastroduodenoscopy (EGD). Dexmedetomidine is a highly selective alpha‐2 adrenergic receptor agonist that has been utilized in combination with propofol to provide anesthesia. There is currently no information regarding the effect of intravenous dexmedetomidine on the propofol plasma concentration–response relationship during EGD in children. This study aimed to investigate the pharmacodynamic interaction of propofol and dexmedetomidine when used in combination for children undergoing EGD. Methods: A total of 24 children undergoing EGD, ages 3–10 years, were enrolled in this study. Twelve children received dexmedetomidine 1 μg·kg^?1 given over 10 min as well as a continuous infusion of propofol delivered by a computer‐assisted target‐controlled infusion (TCI) system with target plasma concentrations ranging from 2.8 to 4.0 μg·ml^?1 (DEX group). Another group of 12 children undergoing EGD also received propofol administered by TCI targeting comparable plasma concentrations without dexmedetomidine (control group). We used logistic regression to predict plasma propofol concentrations at which 50% of the patients exhibited minimal response to stimuli (EC₅₀ for anesthesia). Results: The EC₅₀ ± se values in the control and DEX groups were 3.7 ± 0.4 μg·ml^?1 and 3.5 ± 0.2 μg·ml^?1, respectively. There was no significant shift in the propofol concentration–response curve in the presence of dexmedetomidine. Conclusion: The EC₅₀ of propofol required to produce adequate anesthesia for EGD in children was unaffected by a concomitant infusion of dexmedetomidine 1 μg·kg^?1 given over 10 min.     

The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil

Dexmedetomidine reduces the dose requirements for opioids and anaesthetic agents. We conducted a single-centre, open-label, noncomparative phase II study of the effect of intravenous dexmedetomidine on the dose requirement of propofol to induce loss of consciousness in 49 ASA I and II patients. The initial dexmedetomidine infusion scheme was reduced twice because of adverse events. Forty patients who received the final infusion scheme were randomly allocated to receive one of five stepped propofol infusions; loss of consciousness was assessed after 21 min. The ED50 for the final infusion rate of propofol to suppress consciousness was 3.45 mg x kg(-1) x h(-1) (95% CL 2.7-4.2): ED95 was 6.68 mg x kg(-1) x h(-1) (95% CL 5.1-19.1), EC50 was 1.69 microg x ml(-1) (95% CL 0.95-2.5) and EC95 was 5.7 microg x ml(-1) (95% CL 3.2 to > 10). Our final dose of dexmedetomidine of 0.63 microg x kg(-1) caused a reduction in the overall concentration and dose of propofol required to produce loss of consciousness, but no significant shift in the dose-response curve compared with other studies.     

Effects of dexmedetomidine on propofol and remifentanil infusion rates during total intravenous anesthesia for spine surgery in adolescents

Introduction: Total intravenous anesthesia with propofol and a synthetic opioid is a frequently chosen anesthetic technique for posterior spinal fusion. Despite its utility, adverse effects may occur with high or prolonged propofol dosing regimens including delayed awakening. The current study investigated the propofol‐sparing effects of the concomitant administration of the α₂‐adrenergic agonist, dexmedetomidine, during spinal fusion surgery in adolescents. Methods: The surgical database of the department of orthopedic surgery was searched and patients (12–21 years of age) were identified who had undergone spinal fusion for either idiopathic or neuromuscular scoliosis during the past 24 months. Patients were assigned to two groups. Group 1 included patients anesthetized with propofol and remifentanil and group 2 included patients anesthetized with dexmedetomidine, propofol, and remifentanil. In the latter group, dexmedetomidine was administered as a continuous infusion of 0.5 μg·kg^?1·h^?1 started after the induction of anesthesia without a loading dose. Propofol was adjusted to maintain the bispectral index (BIS) number at 40–50 and remifentanil was adjusted to maintain the mean arterial pressure (MAP) at 50–65 mmHg. Labetolol or hydralazine was used if the MAP could not be maintained at 50–65 mmHg with remifentanil up to a maximum dose of 0.6 μg/kg/min. Statistical analysis included a nonpaired t‐test for parametric data (age, weight, remifentanil/propofol infusion requirements, and heart rate/blood pressure values). A nonparametric statistical analysis (Dunn) was used to compare BIS numbers. Parametric data are presented as the mean ± sd while nonparametric data are presented as the median and the 95th percentile confidence intervals. Results: Twelve patients received propofol–remifentanil–dexmedetomidine and 24 received propofol–remifentanil. There were no differences in the demographic data, BIS numbers or hemodynamic parameters between the two groups. There was a reduction in the propofol infusion requirements in patients who also received dexmedetomidine (71 ± 11 μg·kg^?1·min^?1) compared with those receiving only propofol–remifentanil (101 ± 33 μg·kg^?1·min^?1, P = 0.0045). No difference was noted in the remifentanil infusion requirements or the use of supplemental agents (hydralazine and labetolol) to maintain controlled hypotension. Conclusion: The concomitant use of dexmedetomidine in patients undergoing spinal fusion reduces propofol infusion requirements when compared with those patients receiving only propofol and remifentanil.     

右旋美托咪定与丙泊酚用于腰硬联合麻醉时NTI与OAA/S镇静评分的比较

目的比较右旋美托咪定和丙泊酚对腰硬联合麻醉下手术患者术中镇静时Narcotrend麻醉指数(NTI)与警觉/镇静评分(OAA/S)的相关性。方法在腰硬联合麻醉下行择期下腹部手术或下肢手术的患者60例,ASAⅠ~Ⅱ级,分为2组,分别为右旋美托咪定组(D组,n=30)、丙泊酚组(P组,n=30)。在腰硬联合麻醉平面稳定且确保麻醉效果后,D组给予0.6、1.2、2.4 ng·mL~(-1)的右旋美托咪定,P组给予1、2、4μg·mL~(-1)的丙泊酚,每个浓度维持20 min。比较两组患者每个时刻点的OAA/S及NTI。结果丙泊酚组在OAA/S为5、4、3、2、1分时的NTI分别为96(89~97)、83(86~82)、66(63~71)、57(50~61)、46(40~50);右旋美托咪定组在OAA/S为5、4、3、2、1分时的NTI分别为94(78~98)、79(83~75)、45(45~52)、38(34~41)、24(20~30)。结论在使用丙泊酚镇静过程中,NTI与OAA/S的相关性好于右旋美托咪定;右旋美托咪定镇静时,NTI和OAA/S联合使用比单独使用NTI更能反映患者的镇静深度。     

Efficacy and effect of TIVA with propofol or dexmedetomidine versus sevoflurane without muscle relaxant during repair of the brachial plexus

BackgroundTotal intravenous anesthesia (TIVA) versus inhalational anesthesia was selected as the anesthetic method, in order to avoid the use of muscle relaxants during repair of brachial plexus injury. We designed this study to determine effect and efficacy of TIVA versus sevoflurane during repair of brachial plexus injury.MethodsSixty patients scheduled for repair of injured brachial plexus from January 2009 till December 2011 were enrolled in this prospective, single-blind, randomized study. They received either inhalation induction with sevoflurane and maintenance with sevoflurane and fentanyl (Group 1) or TIVA with, propofol and fentanyl (Group 2) or TIVA with dexmedetomidine and fentanyl (Group 3). Hemodynamics, intubation conditions, sedation score were assessed. Postoperative pain using visual analogue scale (VAS) was assessed. Discharge time, postoperative respiratory condition, any postoperative complications were recorded.ResultsAll groups provided a similar significant reduction in hemodynamics compared with baseline values. Respiratory rate values of dexmedetomidine–fentanyl group were significantly higher than those in other groups. Oxygen saturation values of dexmedetomidine–fentanyl group were significantly higher than those of propofol–fentanyl group. Time to reach an Aldrete score of 10 was similar in all groups. Patients in sevoflurane–fentanyl group have significantly higher visual analogue score than other groups. Sedation score was higher in the dexmedetomidine–fentanyl group.ConclusionTIVA with propofol and with dexmedetomidine was more effective and favorable anesthesia than sevoflurane anesthesia during repair of brachial plexus injury.     

小剂量右美托咪定联合丙泊酚用于小儿门诊核磁共振检查镇静的临床研究

目的评价小剂量右美托咪定联合丙泊酚用于小儿门诊核磁共振检查（MRI）镇静的临床应用。 方法选取2019年1月至3月在广州市妇女儿童医疗中心行门诊MRI需要镇静的患儿300例，随机分为三组：水合氯醛镇静组（H组，口服10%水合氯醛镇静）；丙泊酚静脉镇静组（P组，静脉推注丙泊酚镇静）；小剂量右美托咪定联合丙泊酚静脉镇静组（DP组，右美托咪定0.3 μg/kg+丙泊酚静脉镇静），各100例。比较三组患者的镇静成功率，镇静效果，呕吐、躁动发生率，呼吸抑制率。 结果P组及DP组的镇静成功率明显高于H组（χ²=18.560，P<0.001），呕吐、躁动发生率明显低于H组（χ²=54.224、17.023，P<0.001、0.001），三组呼吸抑制发生率及需要呼吸支持例数差异无统计学意义（χ²=1.049、1.798，P=0.591、0.407）。DP组需追加丙泊酚例数明显少于P组（χ²=67.520，P<0.001）。镇静过程中，P组及DP组镇静起效时间、苏醒时间、苏醒至离院时间明显短于H组（F=634.100、243.800、42.930，P<0.001、<0.001、<0.001）。 结论小剂量右美托咪定联合丙泊酚静脉镇静用于小儿门诊MRI检查，具有起效快、不良反应少、安全性高、苏醒快等优点，可在小儿门诊镇静推广应用。