目的 比较右美托咪定与芬太尼分别联合丙泊酚用于超声引导下经皮微波消融疗法(percutaueous microwave coagulation therapy,PMCT)治疗肝癌的麻醉效果。方法 ASA Ⅰ～Ⅱ级预行PMCT治疗肝癌患者40例,随机分成芬太尼组(F组,n=20)和右美托咪定组(D组,n=20)。开放静脉后,F组缓慢静脉注射芬太尼1 μg /kg,D组静脉微量泵注射右美托咪定0.5 μg /kg(注射时间为10 min),继以0.5 μg/(kg·h)静脉维持至PMCT结束前5 min左右。局部麻醉下超声引导定位后,F组和D组分别以丙泊酚1～2 mg/kg和0.5 mg/kg(注药速度4 ml/10 s)静脉注射诱导,分别以丙泊酚6～8 mg/(kg·h)和3～4 mg/(kg·h)静脉输注维持至PMCT结束;术中出现呻吟不适或身体扭动者追加丙泊酚20～30 mg/次。观察两组患者丙泊酚用量、苏醒时间、术中BP、HR和SpO₂的变化,以及围术期并发症发生情况。治疗结束后30 min进行VRS疼痛评分并调查患者对麻醉的满意度。结果 丙泊酚用量D组显著低于F组(P＜0.01),苏醒时间D组明显长于F组(P＜0.01)。F组 SBP、DBP和HR在PMCT治疗前后波动大于D组(P＜0.05)。F组心动过缓、低血压、呼吸暂停和注射痛发生率分别为30%、20%、30%及90%,D组患者未有以上情况发生,两组比较差异有统计学意义(注射痛P＜0.01,余P＜0.05)。治疗结束后30 min ,VRS疼痛评分F组明显高于D组(P＜0.01),患者满意率D组明显高于F组(P＜0.05)。结论 两种麻醉方法均能满足PMCT治疗肝癌的需要,但右美托咪定除苏醒时间延长外,能显著减少丙泊酚用量,且不良反应少,对呼吸循环功能影响更小,患者满意率更高。

Objective To compare the anesthetic effect of propofol combined with dexmedetomidine or fentanyl in ultrasonically guided percutaneous microwave coagulation therapy (PMCT) for hepatocellular carcinoma (HCC). Methods Forty HCC patients (ASAⅠ-Ⅱ) were allocated randomly to two groups with 20 cases each. The patients in group F received intravenous anesthesia with fentanyl combined with propofol, and the patients in group D received intravenous anesthesia with dexmedetomidine combined with propofol during PMCT for HCC. The consumption of propofol, recovery time, BP, HR, SpO₂ and complications were assessed. VRS and patient’s satisfactions were assessed at 30 minutes after PMCT. Results The consumption of propofol in group D decreased more than that in group F (P<0.01). The recovery time in group F decreased more than that in group D (P<0.01). The changes of SBP, DBP and HR were more in group F than those in group D (P<0.05). The incidences of bradycardia, hypotension, apnoea and injection pain in group F were higher than those in group D (P<0.05). At 30 min after PMCT, VRS in group D decreased more than that in group F (P<0.01). The patient’s satisfactions in group F decreased more than that in group D (P<0.05). Conclusions Propofol combined with dexmedemidine or fentanyl provides satisfactory anesthesia for the operation of HCC with ultrasonically guided PMCT, but anesthesia with dexmedemindine increases recovery time and patient’s satisfactions, decreases consumption of propofol and adverse reactions, and has less effect on the respiratory and circulatory function than that with fentanyl.