右美托咪定清醒镇静对帕金森病患者脑深部电刺激植入术喉罩全麻的影响

摘要

目的 探讨右美托咪定清醒镇静对帕金森病 (Parkinson's Disease,PD)患者脑深部电刺激植入术 (deep brain electric stimulus implantation, DBS)喉罩全麻的影响.方法 选择择期行双侧丘脑底核DBS的PD患者40例,男32例,女8例,年龄18~75岁,ASA Ⅰ或Ⅱ级.随机将患者分为右美托咪定组 (D组)和对照组 (C组),每组20例.手术分两阶段进行:第一阶段在局麻下放置电极,CT检查证实电极放置满意为第一阶段结束;第二阶段需在全麻下埋置脉冲发生器于胸前皮下.D组在入室后15 min内经静脉匀速泵入负荷剂量右美托咪定0.5 μg/kg,继之以0.1~0.3 μg·kg-1·h-1持续泵注至手术第一阶段结束;C组泵入同等剂量生理盐水.记录微电极受干扰和震颤减轻次数;记录患者入室时 (T0)、局部浸润麻醉时 (T1)、一侧电极植入时 (T2)、对侧电极植入时 (T3)、第一阶段结束时 (T4)的Ramsay镇静评分;记录意识消失时间、喉罩置入时间、自主呼吸恢复时间和拔管时间;记录全麻开始至手术结束丙泊酚、瑞芬太尼总用量.结果 两组患者微电级受干扰、震颤减轻发生率差异无统计学意义;D组T1~T4时的Ramsay评分明显高于C组(P<0.05),意识消失时间、喉罩置入时间、自主呼吸恢复时间和拔管时间明显短于C组(P<0.05),全麻开始至手术结束丙泊酚、瑞芬太尼总用量明显少于C组(P<0.05).结论 右美托咪定可为帕金森病脑深部电刺激植入术第一阶段提供良好镇静;并能缩短第二阶段喉罩全麻诱导及苏醒时间,减少丙泊酚、瑞芬太尼用量.%Objective To observe the anesthesia related effect of dexmedetomidine conscious sedation on Laryngeal mask airway general anesthesia in Parkinson patients with deep brain electric stimulus implantation.Methods Forty patients (72 males, 8 females, aged 18-75 years, ASA physical status Ⅰ or Ⅱ) of Parkinson disease with selective operated bilateral subthalamic nucleus deep brain electric stimulus implantation were selected and randomly divided into dexmedetomidine group (group D) and contrast group (group C), 20 cases in each group.The operation divided into two stages: in the first stage, the electrode was put under the local anesthesia, CT examination proof of electrode placement satisfaction was the end of the first stage.The second stage needed to bury the pulse generator under of the chest skin under general anesthesia.For group D, dexmedetomidine 0.5 μg/kg was pumped venously within 15 min after entering the operating room, the speed of 0.1-0.3 μg·kg-1·h-1 was kept subsequently until the end of the first period.For group C, the same dosage of normal saline was pumped.The times of micro-electrode interference, tremor relief were recorded.Ramsay scores of two groups of patients were recorded at the entry of operating room (T0), partial infiltration anesthesia (T1), unilateral electrode implantation (T2), contralateral electrode implantation (T3), the end of the first period (T4);the time needed to vanish consciousness, implant laryngeal mask airway, recover the spontaneous breathing and extubation were recorded;the propofol, remifentanil dosage from the beginning of general anesthesia induction to the end of the surgery were recorded.Results The micro-electrode was intervened and tremble was relieved in both two groups.Compared with group C, the ramsay scores of T1-T4 were obviously increased in group D (P<0.05), the time needed to vanish consciousness, implant laryngeal mask airway, recover the autonomous respiration, extubation were significantly shortened in group D (P<0.05), the dosage of propofol, remifentanil from the beginning of the general anesthesia starts to the end of the surgery were significantly reduced in group D (P<0.05).Conclusion Dexmedetomidine provided the excellent sedation to the first period of Parkinson patients with deep brain electric stimulus implantation;it can shorten the time of the anesthesia induction and awakening time, as well as decreases propofol and remifentanil dosage.