费建平 1冯树全 1潘鹏 1袁林芳 1赵赢 1俞灵 1陆培春1
作者信息
- 1. 昆山市中医医院麻醉科,江苏昆山 215300
- 折叠
摘要
Abstract
Objective To compare the sedative effect of continuous infusion of remazolam and low-dose dexmedetomidine with remazo-lam,and to explore the method of combined administration of remazolam.Methods Fifty patients ASA Ⅰ to Ⅱ undergoing elective lower limb surgery under spinal anesthesia were randomly assigned to the control group(Group C,n=25)and the experimental group(Group S,n=25)by random number table method.Patients in Group C continued to receive 0.3 mg/(kg·h)of remazolam by pump until post-operative completion.Patients in Group S received continuous infusion of dexmedetomidine at 1.2 μg/(kg·h),which was lowered to 0.4 μg/(kg·h)after 20 minutes.At the same time,remazolam was pumped at 0.3 mg/(kg·h),which was lowered to 0.2 mg/(kg·h),20 minutes later.The circulatory changes of the patient at 10 minutes(T0)after entry and 10 minutes(T1),20 minutes(T2),45 minutes(T3),60 minutes(T4)after intravenous administration,as well as intraoperative(T5)and postoperative(T6)changes were observed and recorded.The time and BIS values of sedation onset,mild sleep and deep sleep,as well as the lowest intraoperative BIS value and Ramsay score were observed and recorded.Meanwhile the recovery of BIS values and awakening time after discontinuation of medication were observed and recorded.Central venous blood gas was collected after the patient entering the room,during the patient's mild sleep,deep sleep and at the end of the surgery,then the central venous oxygen saturation(ScvO2)and central venous blood partial pressure of carbon dioxide(PcvCO2)were analyzed and compared.Results The onset time of sedation in Group C and Group S were(10.14±3.33)min and(9.32±2.62)min respectively,with no statistically significant difference(P＞0.05).Compared with Group C,the time of mild sleep and deep sleep in Group S was significantly shortened,with statistically significant differences(P＜0.05).The BIS value during deep sleep and the lowest intraoperative BIS value in Group S were lower than those in Group C,and the Ramsay sedation score during surgery was higher than that in Group C,with statistically significant differences(P＜0.05);after 5 min,10 min,and 15 min of discon-tinuation,the BIS values of Group S were lower than those of Group C,with statistically significant differences(P＜0.01).After 10 min of discontinuation,12 patients in Group S regained consciousness,while 22 patients regained consciousness in Group C with statistically significant differences(P＜0.01).Compared with T0,PcvO2,ScvO2 and PcvCO2 in both groups increased during mild sleep,deep sleep and postoperative periods(P＜0.01);during deep sleep,the ScvO2 and PcvCO2 levels in Group S were higher than those in Group C,with statistically significant differences(P＜0.05).There were 4 cases of adverse reactions,including coughing and irritability in Group C,and 6 cases of patients remaining alert throughout the entire process.However,there were no adverse reactions in Group S.Conclusion The continuous infusion of low-dose dexmedetomidine combined with remazolam has stable sedation effect and few adverse reactions,which can be safely applied to patients undergoing subarachnoid block surgery.关键词
瑞马唑仑/右美托咪定/联合用药/辅助镇静Key words
remazolam/dexmedetomidine/combined medication/assisted sedation
