目的：在气管切开MAC中，将局麻联合帕瑞昔布钠超前镇痛和右美托咪啶泵注与单纯局麻进行对比，对前者的麻醉效果进行评估。方法：ASAⅡ~Ⅲ级40例行气管切开手术的患者，按照随机数字表法将其分为镇痛组（局麻+帕瑞昔布钠右美托咪啶组）和对照组（单纯局麻组），每组20例。镇痛组切皮前30 min静注帕瑞昔布钠40 mg，同时微量泵持续静脉注射右美托咪啶1μg/kg（15 min内注射完毕），随后右美托咪啶0.4μg/（kg·h）持续泵注，观察并记录两组给药前（T0）、切皮时（T1）、深部手术操作（T2）、缝皮时（T3）4个时点患者的血压（SP、DP）、心率（HR），血氧饱和度（SpO2）和术中体动反应个数。结果：切开气管操作时，对照组与镇痛组比较，心率、血压、明显上升，体动个数明显增多，差异均有统计学意义（P<0.05），术中有62%的患者需要追加深部局部浸润麻醉。两组SpO2各时点比较差异无统计学意义（P>0.05）。结论：局麻联合帕瑞昔布钠超前镇痛和右美托咪啶泵注用于气管切开患者，镇静镇痛效果好，呼吸循环稳定。%Objective:To compare local anesthesia jointly used with parecoxib preemptive analgesia and dexmedetomidine injection with simple local anesthesia in monitored anesthesia care(MAC) of patients receiving tracheostomy and to evaluate the anesthetic effect of the former.Method:ASAⅡ-Ⅲ forty patients with tracheostomy were randomly divided into the analgesia group and the control group,20 cases in each group.Thirty minutes before incision,the analgesia group was given parecoxib 40 mg,during which 1 μg/kg of continuous intravenous infusion of dexmedetomidine in 15 minutes was given the micro infusion pump and later a 0.4 μg/(kg·h)continous dexmedetomidine injection was given.Then a series of patients’ indexes including Bp(SP,DP),HR,SpO2 and the number of body activities were observed and recorded at such four timings as:pre-infusion(T0), cut skin (T1),deep operation (T2) and surgical sutures(T3).Result:Cut windpipe operation,the control group compared with analgesia group, increased heart rate,blood pressure and body move number increased significantly,the difference had statistical significance (P<0.05),in 62% of patients required additional deep local infiltration anesthesia.SpO2 each point was similar between the two groups has no statistical significance (P>0.05). Conclusion:The use of local anesthesia combined with parecoxib preemptive analgesia and dexmedetomidine used for patients after tracheostomy,it can yield marked analgesic and sedative effect and stable respiration and circulation.
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