右美托咪啶对肝癌高强度聚焦超声治疗患者苏醒期躁动的影响

目的：评价右美托咪啶对全麻下肝癌高强度聚焦超声（high intensity focused ultrasound，HIFU）治疗患者苏醒期躁动的影响。方法第二炮兵总医院2009年12月-2013年1月择期肝癌HIFU治疗患者100例，年龄48~80岁，体重指数（BMI）18.2~26.5 kg/m2，美国麻醉医师协会（American Society of Anesthesiology，ASA）分级Ⅱ~Ⅲ级，将患者随机分为2组（n=50）：对照组（C组）及右美托咪啶组（D组）。D组麻醉诱导前经15 min静脉输注右美托咪啶负荷量0.7μg/kg，随后以0.2μg/（kg·h）的速率静脉输注至术毕，C组给予等容量0.9%氯化钠溶液。负荷量输注完毕后5 min 2组均静脉注射芬太尼2~3μg/kg、丙泊酚1.5~2 mg/kg和顺阿曲库铵0.2 mg/kg麻醉诱导。麻醉维持：吸入七氟醚（呼气末靶浓度1.5%~2%），泵入瑞芬太尼0.01~0.02 mg/（kg·h），泵入丙泊酚1.5~2 mg/（kg·h），按需追加顺阿曲库铵0.05 mg/kg，维持脑电双频指数（bispectral index，BIS）40~60。记录丙泊酚、瑞芬太尼和七氟醚的用量、苏醒期躁动及术后24 h内谵妄发生情况。结果与C组比较，D组丙泊酚、瑞芬太尼和七氟醚的用量减少，苏醒期躁动发生率及术后24 h内谵妄的发生率降低（P＜0.05），术中D组患者心率（heart rate，HR）降低（P＜0.05）。结论右美托咪啶可有效降低降低肝癌HIFU治疗患者苏醒期躁动的发生率，同时也降低了患者全麻用药量。

Effect of dexmedetomidine on agitation in awakening period of liver cancer patients after high intensity focused ultrasound therapy

Objective To assess the effect of dexmedetomidine on agitation in awakening period of liver cancer patients after high intensity focused ultrasound （HIFU） therapy. Methods One hundred 48-80 years old ASAⅡorⅢliver cancer patients with their BMI being 18.2-26.5 kg/m2, admitted to General Hospital of Second Artillery Forces for HIFU therapy from December 2009 to January 2013, were randomly divided into control group and dexmedetomidine treatment group （50 in each group）. Patients in dexmedetomidine treatment group were intravenously infused at the dose of 0.7μg/kg for 15 min before anesthesia followed by 0.2 μg/（kg · h） till the end of operation and those in control group were infused with the equal volume of 0.9%sodium chloride solution. Patients in both groups were anesthetized through iv injection of fentanyl （2-3μg/kg）, propofol （1.5-2 mg/kg）and cisatracurium （0.2 mg/kg） 5 min after the loading dose was infused and maintained by inhaling sevoflurane （the end-tidal concentration was 1.5%-2%） and pumping remifentanil [0.01-0.02 mg/（kg · h）] and propofol [1.5-2 mg/（kg · h）] into trachea, and adding cisatracurium （0.05 mg/kg） when needed with the BIS maintained at 40-60. The volume of propofol, remifentanil and sevoflurane used, and the incidence of agitation in wakening period and delirium within 24 h after operation were recorded. Results The volume of propofol, remifentanil and sevoflurane used, the incidence of agitation in awakening period and delirium within 24 h after operation, and the heart rate were significantly lower in dexmedetomidine treatment group than in control group （P〈0.05）. Conclusion Dexmedetomidine can effectively reduce the incidence of agitation in awakening period of liver cancer patients after HIFU therapy and the volume of narcotics.