目的 评价在肝癌射频消融术(radiofrequency ablation,RFA)中使用右美托咪定复合瑞芬太尼后的镇静和镇痛效果。方法 选择美国麻醉师协会分级标准为Ⅱ~Ⅲ级择期行RFA的肝癌患者60例,随机分为右美托咪定+瑞芬太尼组(Dex组)和丙泊酚+瑞芬太尼组(对照组),每组30例。分别记录两组局麻浸润前15 min(T₀)、局麻浸润时(T₁)、手术开始时(T₂)、射频温度达峰值时(T₃)、术毕烧针道时(T₄)及停药后5 min(T₅)时的心率(HR)、血压(收缩压SBP、舒张压DBP)、呼吸频率(R)、血氧饱和度(SPO₂)、清醒镇静评分(OAA/S)、脑电双频指数(BIS),同时记录围术期不良反应及患者满意度。结果 Dex组在围术期的收缩压、舒张压、呼吸频率、血氧饱和度的变化趋势与对照组相比有统计学差异(F=2.496,P=0.033;F=2.658,P=0.025;F=11.900,P=0.000;F=6.378,P=0.000),心率变化趋势没有统计学差异(F=0.704,P=0.622);Dex组OAA/S评分低于对照组(F=6.978,P=0.000),Dex组BIS高于对照组(F=519.780,P=0.000);Dex组在围术期呼吸抑制、术中体动、恶心呕吐及苏醒延迟少于对照组(χ²=15.635,P=0.000、χ²=9.834,P=0.000、χ²=6.613,P=0.013);Dex组患者满意度高于对照组(χ²=7.938,P=0.000)。结论 肝癌患者在RFA中使用右美托咪定复合瑞芬太尼可获得满意的镇痛镇静效果,患者可被唤醒,麻醉管理更加安全高效。

Objective To evaluate effects of sedation and analgesia of dexmedetomidine hydrochloride injection combined with remifentanil during radiofrequency ablation among patients with liver cancer.Methods Sixty patients with liver cancer were equally divided into two groups: the dexmedetomidine hydrochloride injection group treated with dexmedetomidine hydrochloride injection combined with remifentanil and the control group treated with propofol plus remifentanil. The heart rate, blood pressure, respiratory rate, oxygen saturation, observer’s assessment of alertness/sedation(OAA/S), bispectral index of patients were recorded at 15 minutes before local anesthesia(T₀), during local anesthesia(T₁), at the beginning of the operation(T₂), the time radio frequency reached the highest temperature(T₃), at the end of the operation(T₄) and 5 minutes after suspension of medication(T₅). Perioperative adverse reactions and patients’ rate of satisfaction were also recorded.Results The changes of systolic blood pressure, diastolic blood pressure, respiratory rate, oxygen saturation in the dexmedetomidine hydrochloride injection group were significantly different from those of the control group (F=2.496,P=0.033;F=2.658,P=0.025;F=11.900,P=0.000;F=6.378,P=0.000).But the change of heart rate was not significantly different between the two groups (F=0.704,P=0.622). OAA/S in the dexmedetomidine hydrochloride injection group was lower than that of the control group (F=6.978,P=0.000). The bispectral index of the dexmedetomidine hydrochloride injection group was higher than that of the control group (F=519.780,P=0.000).The incidence of respiratory depression, perioperative body movement, nausea and vomiting, and delayed recovery in the dexmedetomidine hydrochloride injection group was lower than in the control group(χ²=15.635,P=0.000、χ²=9.834,P=0.000、χ²=6.613,P=0.013). The rate of patient satisfaction in the dexmedetomidine hydrochloride injection group was higher than that of the control group(χ²=7.938,P=0.000).Conclusions Patients with liver cancer who have received dexmedetomidine hydrochloride injection during radiofrequency ablation can get good sedative and analgesic effect. Patients can be awakened. Anesthesia is safer and more effective.