乳腺微创旋切时右美托咪定辅助镇静的适宜剂量

doi:10.12092/j.issn.1009-2501.2025.08.012

摘要/Abstract

摘要： 目的：探讨静脉应用右美托咪定（dexmedetomidine,Dex）在区域阻滞下乳腺微创旋切术中辅助镇静的适宜剂量。方法：选择120例乳腺多发性肿块患者,按随机数字表法分为Dex 0.5 μg/kg组（D₁组）、Dex 0.75 μg/kg组（D₂组）、Dex 1.0 μg/kg组（D₃组）和生理盐水组（C组）,静脉注射试验用药后行乳腺后间隙麻醉下微创旋切术。比较术中最适镇静率,术后最适镇静率,麻醉前、静脉用药结束、乳腺后间隙麻醉、手术开始、手术5 min、术毕、静脉用药30 min、静脉用药60 min的Ramsay镇静评分,疼痛视觉模拟评分（VAS）,生命体征[收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏氧饱和度（SpO₂）],中度及以上疼痛（VAS>3）发生率及不良反应,其中术中和术后最适镇静分别定义为术中Ramsay评分2~4分和术后Ramsay评分2~3分。结果：Dex具有剂量依赖性镇静镇痛作用,术中最适镇静率D₂、D₃组明显高于C组和D₁组,术后最适镇静率D₂组最高;D₂组和D₃组术中中度及以上疼痛发生率明显低于C组和D₁组,且D₂组、D₃组之间无统计学差异;D₂组和D₃组的头晕发生率高于C组和D₁组;各组低血压、高血压、严重心动过缓、低氧血症及恶心的发生率无统计学差异。结论：术前单次静脉应用0.75 μg/kg右美托咪定镇静镇痛效果确切,术中和术后最适镇静率高,是区域阻滞下乳腺微创旋切术辅助镇静的适宜剂量。

关键词: 右美托咪定, 镇静, 区域阻滞, 乳腺微创旋切术

Abstract: AIM: To investigate the appropriate dose of intravenous dexmedetomidine (Dex) for sedation in minimally invasive breast surgery under regional block. METHODS: A total of 120 patients with multiple breast masses were selected and divided into Dex 0.5 μg/kg group (group D₁), Dex 0.75 μg/kg group (group D₂), Dex 1.0 μg/kg group (group D₃) and normal saline group (group C) according to the random number table method. After intravenous injection of test drugs, minimally invasive rotary cutting under retromammary space anesthesia was performed. The optimal sedation rate during operation, the optimal sedation rate after operation, Ramsay sedation scores were recorded before anesthesia, at the end of intravenous administration, at the retromammary space anesthesia, at the beginning of surgery, 5 min after surgery, at the end of surgery, 30 min after administration, and 60 min after administration, visual analogue scale (VAS), vital signs (SBP, DBP, HR, SpO₂), the incidence of moderate and above pain (VAS>3) and adverse reactions were observed. The optimal sedation was defined as intraoperative Ramsay score 2-4 points and postoperative Ramsay score 2-3 points. RESULTS: Dex had a dose-dependent sedative and analgesic effect. The optimal sedation rate during operation in group D₂ and D₃ was significantly higher than that in group C and D₁, and the optimal sedation rate after operation in group D₂ was the highest. The rate of VAS score greater than 3 points in group D₂ and group D₃ was significantly lower than that in group C and group D₁, and there was no statistical difference between group D₂ and group D₃. The incidence of dizziness in group D₂and group D₃ was higher than that in group C and group D₁. There was no significant difference in the incidence of hypotension, hypertension, severe bradycardia, hypoxemia and nausea among the groups. CONCLUSION: Preoperative single intravenous application of 0.75 μg/kg dexmedetomidine has a definite sedative and analgesic effect, and the optimal sedation rate during and after operation is high. It is an appropriate dose for sedation assisted by minimally invasive breast surgery under regional block.

Key words: dexmedetomidine, sedation, regional block, minimally invasive breast atherectomy

中图分类号:

R614

陈建筱, 吕昊, 郭小文. 乳腺微创旋切时右美托咪定辅助镇静的适宜剂量[J]. 中国临床药理学与治疗学, 2025, 30(8): 1105-1111.

CHEN Jianxiao^{1, 2}, LV Hao², GUO Xiaowen³. Appropriate dose of dexmedetomidine assisted sedation in minimally invasive breast surgery[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2025, 30(8): 1105-1111.

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