右美托咪定联合靶控输注丙泊酚在肝癌射频消融治疗中的临床效果

doi:10.12092/j.issn.1009-2501.2018.06.014

中国临床药理学与治疗学 ›› 2018, Vol. 23 ›› Issue (6): 682-687.doi: 10.12092/j.issn.1009-2501.2018.06.014

右美托咪定联合靶控输注丙泊酚在肝癌射频消融治疗中的临床效果

赵鹏程¹，徐丽丽²，李艳玲²

¹杭州市西溪医院麻醉科，杭州 310023，浙江；²浙江中医药大学附属第二医院麻醉科，杭州 310005，浙江

收稿日期:2018-03-09 修回日期:2018-04-04 出版日期:2018-06-26 发布日期:2018-06-19
作者简介:赵鹏程，男，本科，主治医师，研究方向：临床麻醉学。 Tel:13758105402 E-mail: xbz@163.com
基金资助:
浙江省中医药科技计划项目（2018ZB065）

Effects and safety of target controlled infusion of propofol combined with dexmetomidine in radiofrequency ablation of primary liver cancer

ZHAO Pengcheng¹, XU Lili², LI Yanling²

¹Department of Anesthesiology, Xixi Hospital, Hangzhou 310023,Zhejiang，China; ² Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005, Zhejiang，China

Received:2018-03-09 Revised:2018-04-04 Online:2018-06-26 Published:2018-06-19

摘要/Abstract

摘要：

目的：观察右美托咪定联合靶控输注丙泊酚在肝癌射频消融治疗中的临床效果。方法：选择拟行局部消融治疗的原发性肝癌患者68例，随机分为Dex组（34例）和对照组（34例），对照组采用丙泊酚靶控输注复合瑞芬太尼麻醉方案，Dex组在对照组的基础上联合应用右美托咪定（负荷量0.5 μg/kg，后续以0.2~0.4 μg·kg-1·h-1泵入）。比较两组患者丙泊酚和瑞芬太尼的用量，术中镇痛效果，麻醉满意度，两组麻醉期间的血流动力学和血氧饱和度以及术中循环呼吸不良反应情况。结果：对照组的手术时间与Dex组无明显差异（t=1.010，P=0.316），而Dex组的丙泊酚和瑞芬太尼用量以及苏醒时间均显著低于对照组（t=15.174, 9.703, 32.866，P=0.000, 0.000, 0.000）。Dex组患者穿刺时和消融时的行为疼痛量表（BPS）评分均显著低于对照组（t=10.678, 9.451，P=0.000, 0.000），麻醉满意度明显高于对照组（t=6.887，P=0.000）。与T0时刻相比，两组患者T1时刻的心率（HR）、平均动脉压（MAP）和T1、T2、T3时刻血氧饱和度（SpO2）均出现明显降低（P<0.05），其中，Dex组患者的HR、MAP和SpO2均显著高于对照组（P<0.05）；与T0和T4时刻相比，对照组T2、T3时刻的HR和MAP均明显升高（P<0.05），且对照组T2、T3时刻的HR和MAP均明显高于Dex组（P<0.05），而Dex组T0、T2、T3、T4时刻的HR和MAP则无明显统计学差异（P>0.05）。对照组术中呼吸循环不良反应发生率为23.53%，显著高于Dex组的5.88%，差异有统计学意义（χ2=4.221，P=0.040）。结论：在原发性肝癌射频消融治疗中应用丙泊酚靶控输注联合右美托咪定能够明显减少丙泊酚和瑞芬太尼的用量，缩短苏醒时间，对循环和呼吸指标的干扰较小，并具有较低的不良反应发生风险。

关键词: 原发性肝癌, 射频消融, 丙泊酚, 靶控输注, 右美托咪定

Abstract:

AIM: To observe the effects and safety analysis of propofol target-controlled infusion combined with dexmedetomidine in radiofrequency ablation of primary liver cancer. METHODS: Sixty-eight patients with primary liver cancer who underwent radiofrequency ablation in our hospital from February 2016 to January 2018 were randomly divided into Dex group (34 cases) and control group (34 cases). The control group was given propofol target-controlled infusion combined with remifentanil anesthesia program; on the basis of the control group, the Dex group used dexmedetomidine (first load was 0.5 μg/kg, and followed by 0.2-0.4 μg·kg^-1·h^-1 pumped). The dosage of propofol and remifentanil in two groups were compared, the intraoperative analgesia effect, anesthesia satisfaction, hemodynamics and oxygen saturation during anesthesia and intraoperative respiration adverse reactions were compared between the two groups. RESULTS: There was no significant difference of surgery time between the control group and the Dex group ( t=1.010, P=0.316), while the dosage of propofol and remifentanil as well as the waking time in the Dex group was significantly lower than those of the control group ( t=15.174, 9.703, 32.866, P=0.000, 0.000, 0.000). The BPS scores at puncture and ablation in Dex group were significantly lower than those in control group ( t=10.678, 9.451, P=0.000, 0.000), while the anesthesia satisfaction was significantly higher than that in control group ( t=6.887, P=0.000, 0.000). Compared with T0, HR, MAP, and SpO2 at T1, T2 and T3 decreased significantly in both groups ( P<0.05), and HR, MAP and SpO2 in Dex group were significantly higher than those in control group (P<0.05). Compared with T0 and T4, the HR and MAP of T2 and T3 in control group were significantly increased (P<0.05), and the HR and MAP of T2 and T3 in control group were significantly higher than that of Dex (P<0.05). There was no significant difference in HR and MAP between Dex group at T0, T2, T3 and T4 (P>0.05). The incidence of adverse respiratory and circulatory reactions in the control group was 23.53%, which was significantly higher than that in the Dex group (5.88%). The difference was statistically significant (χ²=4.221, P=0.040). CONCLUSION: Target controlled infusion of propofol combined with dexmetomidine in radiofrequency ablation of primary liver cancer can significantly reduce the dosage of propofol and remifentanil, shorten the recovery time, and have less interference with circulatory and respiratory indexes. Also, it has a lower risk of adverse reactions.

Key words: primary liver cancer, radiofrequency ablation, propofol, target controlled infusion, dexmedetomidine

中图分类号:

R614

赵鹏程，徐丽丽，李艳玲. 右美托咪定联合靶控输注丙泊酚在肝癌射频消融治疗中的临床效果[J]. 中国临床药理学与治疗学, 2018, 23(6): 682-687.

ZHAO Pengcheng, XU Lili, LI Yanling. Effects and safety of target controlled infusion of propofol combined with dexmetomidine in radiofrequency ablation of primary liver cancer[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2018, 23(6): 682-687.

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右美托咪定联合靶控输注丙泊酚在肝癌射频消融治疗中的临床效果

Effects and safety of target controlled infusion of propofol combined with dexmetomidine in radiofrequency ablation of primary liver cancer

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