右美托咪定与瑞芬太尼对喉罩全身麻醉下胸腔镜交感神经链切除术治疗手汗症的麻醉效果比较

摘要

目的 探讨右美托咪定与瑞芬太尼对喉罩全身麻醉下胸腔镜交感神经链切除术治疗手汗症的麻醉效果.方法 选取2012年1月至2014年9月在广州医科大学附属第一医院因手汗症行电视胸腔镜下双侧胸交感神经链部分切除术患者48例,根据随机数字表法分为右美托咪定组与瑞芬太尼组,每组24例.2组患者均采用喉罩全身麻醉.将麻醉前,手术开始15、30 min,手术结束后30、60 min分别记为T1、T2、T3、T4、T5.记录2组患者术前、术中和术后基本生命体征、术野满意度与疼痛视觉模拟量表(VAS)评分.结果 T2、T3时点,右美托咪定组患者呼吸频率较瑞芬太尼组快[(20.1±5.3)次/min比(11.4±2.3)次/min,(20.3±3.7)次/min比(14.3±3.6)次/min],潮气末二氧化碳分压明显较瑞芬太尼组低[(37 ±5) mmHg(1 mmHg =0.133 kPa)比(51±7)mmHg,(37±5)mmHg比(48±7)mmHg],差异有统计学意义(P＜0.01).与瑞芬太尼组比较,右美托咪定组患者T2、T4时点心率较慢[(61±7)次/min比(66±8)次/min,(69±8)次/min比(77±10)次/min],T3、T4时点平均动脉压较低[(73±12) mmHg比(81±13) mmHg,(78 ±8) mmHg比(88 ±11) mmHg],差异有统计学意义(P＜0.01或P＜0.05).2组患者各时点SpO2比较,差异无统计学意义(P＞0.05).与瑞芬太尼组相比,右美托咪定组术中术野满意度更高[62.5％ (15/24)比29.2％(7/24)]、术后T4、T5时点VAS评分更低[(2.2±0.7)分比(4.6±1.0)分,(2.5±0.9)分比(4.2±1.0)分],差异有统计学意义(P＜0.05).结论 右美托咪定应用于喉罩全身麻醉下胸腔镜交感神经链切除术较瑞芬太尼更加安全、有效.%Objective To observe the anaesthesia effects of dexmedetomidine versus remifentanil in video-assisted thoracoscopic surgery of sympathicotomy under laryngeal mask anesthesia in patients with palmer hyperhidrosis.Methods Totally 48 patients with palmer hyperhidrosis undergoing sympathicotomy with video-assisted thoracoscopic surgery from Junuary 2012 to September 2014 were randomly assigned into dexmedetomidine group (24 cases) and remifentanil group (24 cases).Laryngeal mask anesthesia was used.The basic vital sign,surgical field satisfaction and visual analog scales (VAS)score were recorded before anesthesia (T1),before surgery (T2),30 min after start of surgery (T3),30 min and 60 min after the end of surgery (T4,T5).Results The respiratory rate was significantly faster,the end tidal carbon dioxide was significantly lower in dexmedetomidine group,compared with those in remifentanil groupat T2 [(20.1 ± 5.3) times/min vs (11.4 ± 2.3) times/min,(37 ±5) mmHg vs (51 ±7) mmHg] and T3 time point [(20.3 ±3.7) times/min vs (14.3 ±3.6) times/min,(37 ± 5) mmHg vs (48 ± 7) mmHg] (P ＜ 0.01).The heart rate in dexmedetomidine group was significantly slower than that in remifentanil group at T2 and T4 time points[(61 ±7) times/min vs(66 ±8) times/min,(69 ± 8) times/min vs (77 ± 10) times/min];the mean arterial pressure in dexmedetomidine group was significantly lower than that in remifentanil group at T3 and T4 time points[(73 ± 12) mmHg vs (81 ± 13) mmHg,(78 ± 8) mmHg vs (88 ± 11) mmHg] (P ＜ 0.01 or P ＜ 0.05)].The peripheral oxygen saturation showed no significant differences between the two groups at each time point (P ＞ 0.05).The score of surgical field satisfaction in dexmedetomidine group was significantlyhigher than that in remifentanil group [62.5％ (15/24) vs 29.2％ (7/24)] (P ＜ 0.05).The scores of VAS at T4 and T5 time poin were significantly lower in dexmedetomidine group than those in remifentanilgroup[(2.2 ±0.7) score vs (4.6±1.0) scores,(2.5 ±0.9) scores vs (4.2±1.0) scores] (P ＜ 0.05).Conclusion Compared with remifentanil,dexmedetmindine is more safe and effective during video-assisted thoracoscopic surgery of sympathicotomy in treating palmer hyperhidrosis.