右美托咪啶与依托咪酯用于脑功能区手术术中唤醒麻醉的比较

Comparison of Dexmedetomidine and Etomidate in Providing Conscious Sedation for Awake Craniotomy on Cerebral Functional Area

关键词:  右美托咪啶  依托咪酯  开颅术  唤醒麻醉

Key words:  dexmedetomidine  etomidate  craniotomy  conscious sedation

摘要:

目的 比较右美托咪啶和依托咪酯用于脑功能区手术术中唤醒麻醉的有效性和安全性。方法 30例择期脑功能区(运动区病灶)手术患者，随机分为右美托咪啶组(D组)和依托咪酯组(E组)。麻醉诱导为丙泊酚(D组，TCI，Cp 4 μg·mL^-1)或依托咪酯(E组，0.1 mg·kg^-1)、顺苯磺酸阿曲库铵、瑞芬太尼(TCI，Cp 3 ng·mL^-1)。气管插管后2 min，D组丙泊酚Cp调整为2.5 μg·mL^-1，瑞芬太尼Cp调整为2 ng·mL^-1，先在10 min内缓慢静注右美托咪啶负荷量1 μg·kg^-1，然后以0.5 μg·kg^-1·h^-1维持，右美托咪啶负荷量输注结束时，停止丙泊酚TCI；E组瑞芬太尼Cp也调整为2 ng·mL^-1，依托咪酯以10 μg·kg^-1·min^-1泵注维持。在要求唤醒前10 min，两组均将瑞芬太尼Cp减小为0.5 ng·mL^-1，D组右美托咪啶减小为0.2 μg·kg^-1·h^-1，E组停止输入依托咪酯。患者自主呼吸恢复后，若能按指令活动双手及双足，即视其为清醒。在患者清醒配合下，术者利用CES及ECoG定位病灶。在确定手术范围后重新麻醉。观察唤醒时间、唤醒质量、唤醒期间不良事件、围唤醒期生命体征以及术终即刻术者和术后第2天随访时患者对术中唤醒过程的满意度。结果 唤醒时间2组无差异(P>0.05)；唤醒质量D组优于E组(P<0.05)；唤醒期间不良事件平均发生率D组低于E组(P<0.05)；术者及患者对术中唤醒实施过程的满意度D组均高于E组(P<0.05)。结论 右美托咪啶和依托咪酯均可安全有效地应用于脑功能区手术术中唤醒麻醉，比较而言，右美托咪啶的唤醒质量更高，唤醒期间不良事件发生率更低，术者和患者对术中唤醒过程的满意度更高。

Abstract:

OBJECTIVE To compare the efficacy and safety of dexmedetomidine and etomidate in providing conscious sedation for awake craniotomy on cerebral functional area. METHODS Thirty patients(ASA Ⅰ-Ⅱ) scheduled for awake craniotomy on cerebral functional area were randomly divided into two groups: the dexmedetomidine group (group D, n=15) and the etomidate group (group E, n=15). After endotracheal intubation 2 min, in group D, dexmedetomidine 1 μg·kg^-1 was injected iv over 10 min, and then was infused at a rate of 0.5 μg·kg^-1·h^-1; in group E, etomidate was infused at a rate of 10 μg·kg^-1·min^-1. Scalp nerve block and local infiltration of incision and dura mater were performed in both groups. Before expecting awake 10 min, in group D, the rate of dexmedetomidine was decreased to 0.2 μg·kg^-1·h^-1; in group E, etomidate infusion was ceased. The time needed to arouse the patients, the quality of revival, the adverse events and MAP, HR, RE, SPO2, PETCO2 and OAA/S during revival, the degree of satisfaction of surgeons and patients to conscious sedation were observed. RESULTS The time needed to arouse the patients was not significant different in group D and group E(P>0.05). The quality of revival was significantly better in group D than in group E(P<0.05). The adverse events was significantly less in group D than in group E (P<0.05). The degree of satisfaction of both surgeons and patients to conscious sedation were higher in group D than in group E (P<0.05). CONCLUSION Compared with etomidate, in providing conscious sedation for awake craniotomy on cerebral functional area, dexmedetomidine can offer better quality of revival, less adverse events, higher degree of satisfaction of surgeons and patients to conscious sedation.