盐酸右美托咪定复合靶控输注丙泊酚用于肝癌射频消融治疗的临床观察

目的：探讨盐酸右美托咪定复合靶控输注丙泊酚在肝癌射频消融术中应用的有效性及安全性。方法选择射频消融治疗肝癌患者60例，ASAⅠ～Ⅱ级，随机分为3组，每组20例：Ⅰ组（盐酸右美托咪定组）、Ⅱ组（靶控输注丙泊酚组）、Ⅲ组（盐酸右美托咪定+靶控输注丙泊酚组）。记录治疗开始前、治疗开始后5 min、结束即刻、出室时患者的心率（HR）、平均动脉压（MAP）、呼吸频率（RR）、脉搏血氧饱和度（SpO2），同时记录苏醒时间、不良反应发生率、医生满意度评分。结果Ⅱ组治疗开始后5 min MAP（69±8）mmHg]、HR（69±3）次/min]、RR（16±5）次/min]、SpO2（90±4）%]与治疗前相比均明显降低（P<0.05）。Ⅲ组的苏醒时间显著短于Ⅱ组（1.1±0.1）min vs.（3.1±0.2）min，P<0.05]，Ⅲ组的医生满意度评分明显高于Ⅰ组与Ⅱ组（3.8±0.3 vs.1.9±0.3、2.0±0.6，P<0.05）。Ⅲ组呼吸暂停的发生率（0%）及低血压的发生率（5%）也明显低于Ⅱ组（20%、35%，P<0.05）。结论盐酸右美托咪定复合靶控输注丙泊酚用于超声引导下射频消融治疗肝癌安全可靠，患者术中循环呼吸平稳，苏醒快，医生满意度高。

The effectiveness of dexmedetomidine combined with target-controlled infusion of propofol during radiofrequency ablation for liver cancer

Objective To compare the effectiveness and safety of dexmedetomidine (DEX) vs. target control Infu-sion (TCI) of propofol alone vs. DEX plus TCI propofol for radiofrequency ablation (RFA) of liver cancer. Methods Sixty patients scheduled for RFA were randomly allocated into three groups (n=20, each). DEX group (Ⅰ) and TCI propofol group (Ⅱ) and DEX plus TCI propofol group (Ⅲ). Outcome parameters were the procedure duration, the adverse-effect rates and the satisfaction of operators about the quality of aneathesia. The mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and respiration rate (RR) were also monitored and recorded at the following time points:baseline, 5 min after start of procedure, the end of procedure, time of discharge. Results The MAP (69 ±8)mmHg]、HR (69±3)bpm], RR(16±5)] and SpO2(90±4)%] changed significantly 5 min after start of the procedure compared with baseline (P<0.05). The recovery time in group Ⅲ (1.1±0.1)min] was shorter than that in groups Ⅱ (3.1±0.2)min, P< 0.05]. The satisfaction score about the quality of aneasthesia from doctors was significantly higher in group Ⅲ (3.8±0.3) than that in groupⅡ (2.0±0.6)and groupⅠ (1.9±0.3, P<0.05). Moreover, rates of apnea (0%) and hypotension (5%) were lower in group Ⅲ than that in group Ⅱ (20% and 35%, P< 0.05). Conclusion DEX combined with TCI propofol allows stable hemodynamic status, fast recovery as well as high satisfaction. It provides effective and safe sedation for RFA.