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摘要目的：探讨右美托咪定用于局麻下玻璃体切割术的镇静效果。方法：选择拟在局麻监测下行玻璃体切割术患者 50 例为研究对象，年龄 20-72 岁， ASA 分级Ⅱ 级 ~Ⅲ 级，随机分为右美托咪定组（D 组）和咪达唑仑组（M 组），每组 25 例。D 组患者于术前 10 min 静脉泵注右美托咪定 0.5 μg/kg，后以 0.2-0.4 μg/kg.h 的速度持续输注， M 组术前 10 min 缓慢静脉注射咪达唑仑 0.02 mg/kg，术中按需静注 0.5 mg/ 次。维持 VAS 评分≤ 4 分， Ramsay 评分 2-4 分。记录和比较两组患者术中血压、心率、呼吸的变化、辅助用药及患者对镇静效果的满意度。结果：给药后， M 组 T5 时点 MAP 较 T0 显著下降(P<0.05)， D 组 T10 及以后各时点 MAP 较 T0 显著下降(P<0.05)； D 组 T5 及以后各时点 BP 较 T0 显著下降(P<0.05)，但组间及 M 组组内 BP 比较差异无统计学意义(P>0.05)； M 组 T 30 时点 HR 较 T0 显著下降(P<0.01)，而在 T 5 时，组间比较差异有统计学意义(P<0.01)，即 D 组下降更为显著。给药后各时点， D 组 VAS 评分均显著低于 M 组(P<0.05)， 30 min 时达最低。两组 Ramsay 镇静评分给药后 5 min 均达 2 级以上，与给药前比较均显著升高 (P<0.05)， D 组给药后 30 min 及以后各时点 Ramsay 镇静评分均显著高于 M 组 (P<0.01)。给药后各时点，两组组内和组间 SPO2 和 RR 比较均无统计学差异(P>0.05)。D 组患者满意度较 M 组更高(P<0.05)。结论：小剂量右美托咪定用于玻璃体切割术可使患者血流动力学平稳，镇静效果良好，疼痛感觉减轻，舒适度提高。

英文摘要:

ABSTRACT Objective：To investigate the Sedative effect of low-dosage dexmedetomidine and midazolam on patients who would undergo vitrectomy under local anesthesia.Methods： Fifty ASAⅠ ～Ⅱ patients, aged 20-72 yr, undergoing elective vitrectomy under local anesthesia were randomly divided into 2 groups n=25,the dexmedetomidine group and midazolam group. Before operation, patients either infused dexmedetomidine 0.5 μg/kg in 10 min, followed by 0.2-0.4 μg/kg · h, or midazolam 0.02 mg/kg i.v.followed by 0.5 mg i.v. as required. Sedation was titrated toa Ramsay sedation score of2～ 4.Blood pressure, heart rate, respiratory rate,dose of adjuvant drugs and patients'satisfaction were recorded. Results:After infusion, MAP of group M significantly decreased atT 5 compared withT0 , so did group D atT 10 and each time afterT 10 . BP of group D significantly decreased atT 5 and each time afterT 5 compared withT0 , but there was no significant difference between two groups and in group M; HR of group M significantly decreased compared withT0, and at T5, there was statistical difference between groups. The points after infusion, VAS score of group D were significantly lower than that of group M, 30 min to the minimum. Ramsay sedation score of the two groups increased to grade2 at 5 min after infusion, and significantly increased after infusion in group D, which was significantly higher than group M at 30 min and later. There was no difference of SPO 2 and RR between groups and in each group. Patient satisfaction of group D was higher than that of group M (P<0.05).Conclusion: Low-dosage dexmedetomidine as a sedative on patients who would undergo vitrectomy under local anesthesia can improve hemodynamic stabilization, decrease patients' pain perception and increase comfort.

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