目的 探讨右美托咪定（Dex）分别联合丙泊酚或依托咪酯在颅内动脉瘤介入术中的镇静效果及对患者血流动力学的影响。方法 将60例颅内动脉瘤介入术患者按照随机数表法分为A组（Dex+丙泊酚,n=30）、B组（Dex+依托咪酯,n=30）。记录两组不同时间点的平均动脉压（MAP）、心率（HR）,比较苏醒期的镇静效果、呛咳程度、拔管时间、苏醒时间、清醒时间及术后不良反应。结果 A组患者T₁MAP、HR为（84.56±5.13）mmHg、（65.87±5.14）次/分和T₂（83.29±5.47）mmHg、（65.87±5.14）次/分均低于B组T₁（87.89±3.88）mmHg、（70.22±5.67）次/分和T₂（86.71±3.75）mmHg、（69.97±5.87）次/分（t分别为2.836、2.825、3.113、3.391,均P<0.001）。两组苏醒期各项指标和躁动（10.00% vs 0%,P=0.757）、呼吸抑制发生率（3.33% vs 0%,P=0.313）比较差异均无统计学意义（均P>0.05）,A组恶心、呕吐发生率（3.33%）较B组（20.00%）更低（χ²=4.043,P=0.044）。结论 Dex联合丙泊酚、依托咪酯麻醉在颅内动脉瘤介入术中均可发挥良好安全的麻醉作用,降低患者术后躁动和呼吸抑制的发生率,使用Dex联合依托咪酯在患者围插管期的血流动力学的稳定性效果更好,但在降低患者术后恶心呕吐的风险方面效果较差。

Objective To evaluate the sedative effect of dexmedetomidine（Dex）combined with propofol or etomidate during cerebral aneurysm intervention and its effect on patient hemodynamics．Methods A total of 60 cerebral aneurysm patients were randomly divided into two groups：Group A（Dex + propofol,n=30）and Group B（Dex + etomidate,n=30）．Mean arterial pressure（MAP）and heart rate（HR）were recorded at different time points in the two groups,and the sedation effect,choking degree,extubation time,waking up time,waking time and postoperative side effects were compared．Results T₁ MAP,HR of（84.56±5.13）mmHg,（65.87±5.14）times / min and T₂（83.29±5.47）mmHg,（65.87±5.14）times / min in group A were lower than those in group B T₁（87.89±3.88）mmHg,（70.22±5.67）times / min and T₂（86.71±3.75）mmHg,（69.97±5.87）times / min（t=2.836,2.825,3.113,3.391,all P<0.001）．There was no significant difference in the incidence of emergence agitation（10.00 % vs 0.00 %,P=0.757）and respiratory depression（3.33 % vs 0.00 %,P=0.313）between the two groups（P>0.05）．The incidence of nausea and vomiting in group A（3.33 %）was lower than that in group B（20.00 %）（χ²=4.043,P=0.044）．Conclusions Dex combined with propofol and etomidate anesthesia can have a good and safe anesthesia effect in intracranial aneurysm intervention,and reduce the incidence of postoperative agitation and respiratory depression in patients．Hemodynamic stabilization during the tube phase is more effective,but less effective in reducing the risk of postoperative nausea and vomiting in patients．

目的 观察右美托咪定作为佐剂对罗哌卡因在锁骨上入路臂丛神经阻滞效果的影响。方法 将55例上肢择期手术的受试者随机分为右美组和对照组。右美组:30 μg右美托咪定(0.3 mL)＋0.5%罗哌卡因,对照组:生理盐水(0.3 mL)＋0.5%罗哌卡因。在臂丛神经阻滞操作后,按步骤评估和记录臂丛感觉、运动阻滞程度和起效时间。在术中定期监测和记录生命体征、不良事件的发生。手术后评估和记录术毕24小时生命体征、术后镇痛时间、臂丛神经感觉、运动阻滞的持续时间、术后恶心呕吐评分、补救镇痛药物用量和不良事件等数据。结果 在臂丛神经的感觉和运动起效时间、感觉和运动阻滞持续时间、术后镇痛时间方面,右美组长于对照组,存在统计学差异(P<0.05)。两组间在术后生命体征变化、补救镇痛药物用量、术后恶心呕吐评分、不良事件等数据的比较,未见明显统计学差异(P>0.05)。结论 右美托咪定(30 μg)作为佐剂能加快罗哌卡因在锁骨上入路对臂丛神经阻滞的起效时间,增加其术后镇痛时间和对臂丛神经的感觉、运动阻滞时间,同时较少影响患者生命体征,具备一定的有效性和临床安全性。

Objective To observed the effect of dexmedetomidine as an adjunction with ropivacaine in supraclavicularbrachial plexus block. Methods 55 subjects with elective upper extremity operation were randomly divided into two groups: DEX group and control group. The drugs in DEX group was 30 μg dexmedetomidine (0.3 mL) + 0.5% ropivacaine, 20 mL in total. And the one in control group was normal saline (0.3 mL) +0.5% ropivacaine, 20 mL in total. After the operation of brachial plexus block, the value of sensory and motor block of brachial plexus and the onset time were evaluated and recorded according to the protocol. Vital signs and adverse events were monitored and recorded regularly during the operation.Postoperative vital signs, postoperative analgesia time, duration of brachial plexus sensationsensory and motion block, postoperative nausea and vomiting score, dosage of remedial analgesics and adverse events were assessed and recorded in 24 hours after surgery. Results In terms of sensory and motor onset time of brachial plexus, duration of sensory and motor block and postoperative analgesia, DEX group was longer than the control group, with statistical differences (P<0.05).There were no significant statistical differences between the two groups in postoperative vital signs, the amount of remedial analgesic drugs, postoperative nausea and vomiting scores, adverse events etc(P>0.05). Conclusion As an adjuvant, dexmedetomidine (30 μg) can accelerate the onset time of ropivacaine in the supraclavicular approach of brachial plexus block.It can also increase the postoperative analgesia time and sensory and motor block time of brachial plexus.With less impact on the vital signs of patients, the efficacy and clinical safety of dexmedetomidinecan be found in our study.

目的 观察两种不同剂量的阿托品对右美托咪定心脏窦房结及房室结抑制作用的逆转效果。方法 健康志愿者20名,男12名,女8名,18～30岁。受试者先后给予右美托咪啶(1.5±0.5)μg/kg负荷量,持续泵注量(0.75±0.25)μg/(kg·h)进行试验观察。试验过程中如受试者心率＜(50±5)次/分,房室结前传2∶1小于150次/分的受试者随机进入0.5 mg阿托品剂量拮抗组(A₁),1 mg阿托品剂量拮抗组(A₁),每组10例。与泵注前(T₀),静脉泵注右美托咪定后(50±5)min(T₁),阿托品静脉推注后(10±5)min(T₂)经食道左心房调搏测定窦房结恢复时间(SNRT),校正窦房结恢复时间(CSNRT),房室结前传2∶1点阻滞点和房室结有效不应期(AVNERP)测量。结果 组内比较:泵注右美托咪定后T₁时点与基础值T₀时点比较两组窦房结及房室结功能受到抑制,SNRT 均延长(P<0.05),CSNRT比较无差异(P>0.05),房室结前传2∶1阻滞点降低(P<0.05), AVNERP延长(P<0.05)。阿托品使用后T₂时点的A₁组的各指标及A₂组的AVNERP恢复到基础水平(P>0.05),A₂组的SNRT、CSNRT均较T₀时点缩短(P<0.05),A₂组房室结前传2∶1阻滞点均较T₀时点增高(P<0.05)。组间比较:2组T₀时窦房结及房室结功能各指标比较均无差异(P>0.05),T₂时点A₂组SNRT、AVNERP较A₁缩短(P<0.01),T₂时点A₂组2∶1阻滞点均较A₁组增高(P<0.05)。结论 0.5 mg阿托品能逆转右美托咪定心脏窦房结及房室结抑制作用,1 mg阿托品增进右美托咪定影响下的窦房结及房室结传导功能。

Objective To investigate two different doses atropine make reverse effects on the function of sinus node and the atrioventricular node inhibiting action dexmedetomidine (Dex). Methods 20 healthy volunteers were included in the clinical trials aged 18~30 years (12 male, 8 female). The volunteers were administered with Dex at loading dose 1.5±0.5 μg/kg and then at 0.75±0.25 μg/(kg·h). During the trail, the volunteers who happened the minimal heart rate less than 50±5 bpm, atrioventricular node forward 2∶1 block point less than 150 bpm needed to randomly accept 0.5 mg(group A₁)or 1 mg(group A₂)atropine to antagonize(n=10). SNRT, CSNRT, AVN 2∶1 block point and AVNERP were recorded through TELAP. Results Intra-group comparison indicated functional parameters of SN and AVN were inhibited by Dexsat T₁. SNRT were prolonged (P<0.05), AVN 2∶1 block point were decreased (P<0.05),AVNERP were prolonged at T₁ compared with T₀(P<0.05). All indexes in group A₁ and AVNERP in group A₂ were back to basal level after using atropine at T₂(P<0.05). SNRT, CSNRT were shorted at T₂ compared with T₀ in group A₂(P<0.05). AVN 2∶1 block point had more increased at T₂ compared with T₀ in group A2(P<0.05). Inter-group comparison indicated no significant differences in functional parameters of SN、AVN at T₀(P>0.05). SNRT, AVNERP were shorted at T₂ in group A₂ compared with group A₁. AVN 2∶1 block point were increased at T2 in group A₂ compared with group A₁. Conclusion 0.5 mg atropine may reverse the function of SN and AVN that are inhibited by Dex. 1 mg atropine may increase functions of SN and AVN that are inhibited by Dex.

目的 本研究旨在采用连续气道监测法对患者呼吸力学指标进行动态观察,同时监测脑电双频指数（Bispectral index,BIS）和清醒镇静评分（The Observer's Assessment of Alertness/Sedation Scale,OAA/S）,全面系统地评估右旋美托咪定（dexmedetomidine ,Dex）对患者自主呼吸功能和镇静深度的影响,为Dex临床安全应用提供参考依据。方法 80例患者随机分为四组,Dex 0.5 μg/kg组（D₁组）,1.0 μg/kg组（D₂组）,1.5 μg/kg组（D₃组）和对照组（D₀组）,每组病人20例。麻醉诱导前35min分别静脉泵注Dex或0.9%生理盐水10 mL。记录预先给药前（T0 ）、预处理后5min（T1）、10min（T2）、15min（T3）、20min（T4）、25min（T5）和30min（T6）患者的潮气量（V_T）、分钟通气量（MV）、呼气末二氧化碳分压（P_ETCO₂）、呼吸频率（RR）、第一秒呼出率（FEV₁%）、顺应性环（PV环）、阻力环（FV环）、脉搏氧饱和度（SpO₂）、心率（HR）、平均动脉压（MAP）等呼吸力学参数和循环参数及脑电双频谱指数（BIS）及警觉/镇静评分（OAA/S）,并于T0、T1、T3和T6抽取动脉血行血气分析记录PaO₂、PaCO₂和pH值。结果 与对照组相比,D₁组的V_T、RR、MV、P_ETCO₂、FEV₁%、PaCO₂和SpO₂均无变化（P>0.05）,PV环和FV环形态基本正常;D₂组和D₃组MV分别降低16.9%和27.0%;PaCO₂分别升高11.0%和19.9%;FEV₁%分别下降11.0%和14.9%。四组患者均无发生呼吸暂停,而且所有患者SpO₂均在98%或以上。D₃组自主呼吸的PV环和FV环图形面积明显缩小（P<0.05）。D₁组BIS值均在85以上,OAA/S 4分为65%,镇静满意率低,OAA/S 3分仅20%;D₂组镇静满意率最高,OAA/S 3分达70%,且无出现过度镇静;D₃组有60%患者OAA/S评分小于或等于2。结论 静脉泵注Dex所产生的的镇静效应及其对呼吸力学的影响,随着泵注Dex剂量增大,患者镇静程度加深,虽然SpO₂仍在正常范围,但呼吸会受到一定抑制（PV环和FV环图形面积缩小,PaCO₂ 均上升）,临床推荐静脉泵注Dex剂量为0.5 μg/kg~1 μg/kg以策安全。

Objective The purpose of this study was to observe the dynamic indexes of respiratory mechanics in patients with continuous airway monitoring,and to monitor the Bispectral index （BIS） and the Observer's Assessment of Alertness/Sedation Scale （OAA/S）. We evaluated the effect of dexmedetomidine （Dex） on the autonomic respiratory function and the sedative depth of the patients in a comprehensive and systematic way,so as to provide reference for the clinical safety of Dex. Methods In the study,we randomly divided 80 patients into four groups,Dex 0.5,group g/kg （group D₁）,1 group g/kg （group D₂）,1.5 g/kg group （D₃ group） and control group （D₀ group）. There were 20 cases in each group. At about 35min before anesthesia induction,Dex or 0.9% saline 10 mL was injected intravenously. The following time points were selected： pre- administration （T0）,pre-treated 5min （T1）,pre-treated 10min （T2）,pre-processed 15min （T3）,pre-processed 20min （T4）,pre -treated 25min （T5） and pre-treated 30min. The following experimental parameters were recorded at the above time point： tidal volume （VT）,minute ventilation （MV）,end expiratory carbon dioxide partial pressure （P_ETCO₂）,respiratory frequency （RR）,first second exhalation rate （FEV1%）,compliance ring （PV ring）,resistance ring （FV ring）,pulse oxygen saturation （SpO₂）,heart rate （HR）,and respiratory mechanics parameters and circulatory parameters such as mean arterial pressure （MAP）,bispectral index （BIS） and vigilance / sedation score （OAA/S）. At the same time at T0,T1,T3 and T6,arterial blood gas was extracted,and PaO₂,PaCO₂ and pH values were recorded. Results Compared with the control group,the value of VT,RR,MV,PETCO₂,FEV1%,PaCO₂ and SpO₂ in group D₁ did not change significantly （P>0.05）,and the morphology of PV ring and FV ring were basically normal. In group D₂ and group D₃,MV decreased by 16.9% and 27% respectively;PaCO₂ increased by 11% and 19.9% respectively;FEV1% decreased by 11% and 14.9% respectively. No apnea occurred in the four groups,and all patients had SpO₂ at 98% or above. The area of PV rings and FV rings of spontaneous breathing in group D₃ was reduced （P<0.05）. The BIS values in group D₁ were above 85,OAA/S 4 was 65%,sedative satisfaction rate was low,20% patients had a score of 3 in OAA/S;group D₂ had the highest sedative satisfaction rate,70% of patients had a score of 3 in OAA/S,and no excessive sedation;60% of patients in group D₃ with an OAA/S score that was less than or equal to 2. Conclusion The sedation effect that was caused by intravenous infusion of Dex and its effect on respiratory mechanics are as follows： with the increase of Dex's dose,the degree of sedation is deepened. Although SpO₂ is still in the normal range,the respiration will be restrained （the area of PV ring and FV ring is narrowed,the value of PaCO₂ is increased）,and the clinical recommendation of intravenous infusion Dex is at a dose of 0.5µg /kg~1µg /kg for safety reasons. .

目的 探讨不同剂量右美托咪定(Dex)对腰硬联合麻醉下经皮肾镜碎石术患者的镇静效应和安全性。方法 腰硬联合麻醉下行俯卧位经皮肾镜碎石术患者80例,随机分成4组。D1组、D2组、D3组俯卧位后静脉泵注负荷剂量DEX 0.5 μg/kg,输注的时间为10min,随后分别静脉泵注DEX 0.3 μg/(kg·h)、0.5 μg/(kg·h)、 0.7 μg/(kg·h)至术毕;C组俯卧位后静脉泵注生理盐水10 mL/h至术毕。记录T0～T6共7个时点的HR、MAP、p(O₂)和BIS值;在T0、T3～T6等时点对患者静息Ramesay镇静评分;观察患者不良反应发生情况;询问综合满意度。结果 D2组和D3组的HR、MAP、BIS、Ramesay镇静评分在T3~T6等时点明显慢于C组(P＜0.05);D3组心动过缓和头晕等不良反应的发生率明显高于D1组、D2组和C组(P＜0.05),D2组和D3组术中躁动的发生率明显低于D1组和C组(P＜0.05),D1组、D2组和D3组高血压、寒战和恶心呕吐的发生率明显低于C组(P＜0.05),且综合满意度明显高于C组。结论 DEX本药物用于该类手术的镇静疗效及安全性均优于对比的药物。建议临床使用剂量为DEX负荷剂量0.5 μg/kg,随后以0.5 μg/(kg·h)维持。

目的 研究右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中应用的有效性及安全性。方法 选择择期行阴式子宫切除术患者40例(ASA Ⅰ～Ⅱ级),随机分成两组,选择硬腰联合麻醉下手术,麻醉平面固定后以超声引导给予患者双侧腹横肌膜神经阻滞,Ⅰ组患者选用0.5 μg/kg右旋美托咪啶+0.2%罗哌卡因,每侧20 mL,Ⅱ组以相同方法给予同量生理盐水。记录麻醉前(T₀)、麻醉平面确定后(T₁)、手术开始(T₂)、牵拉子宫(T₃)、术毕(T₄)患者的HR、MAP、SpO₂及NTI评分;评价并记录牵拉反应、术后认知功能障碍及谵妄的发生及患者舒适度及满意度。结果 两组患者一般情况无显著性差异(P>0.05);与I组相比,Ⅱ组HR在T₃时刻有显著性降低,差异有统计学意义(P<0.05),牵拉反应评价Ⅰ组评为优的患者个数明显多于Ⅱ组,差异有统计学意义(P<0.05);Ⅰ组舒适度及满意度评定为优的患者个数明显多于Ⅱ组,差异有统计学意义(P<0.05)。结论 右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中应用是安全有效的。

Objective To observe the effectiveness and safety of ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine in elder vaginal hysterectomy. Methods Forty scheduled for vaginal hysterectomy (ASAⅠ～Ⅱ)were randomly assigned to 2 groups. All patients received spinal anesthesia, and ultrasound-guided subcostal transverses abdominis plane block then, Group Ⅰ: 0.5 μg/kg dexmedetomidine and 0.2% ropivacaine 20 mL for each side, and saline was used for Group Ⅱ. HR、MAP SpO₂ and NTI scale were recorded at the time points of pre-anesthesia(T₀), confirmation of anesthesia plane (T₁), beginning of surgery (T₂), pulling uterus (T₃), surgery end(T₄). Effect of dragging reaction, POCD and delirious and degree of comfort and degree of satisfaction of patients were valuated. Results The general condition did not differ between the two groups(P>0.05). Compared to Group Ⅰ, HR of Group Ⅱ at the time point of T3 was significant lower(P<0.05), number of patients with excellent dragging reaction of Group Ⅰ was significant higher (P<0.05)and patients of Group Ⅰ were more comfortable and satisfied than patinents of Group Ⅱ(P<0.05). Conclusion Ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine is effective and safe for vaginal hysterectomy in elderly female.

       目的   评价血塞通联合右美托咪定对脑缺血再灌注损伤大鼠的脑保护效果。方法   选择老龄雄性Wistar大鼠50只，随机分为假手术（C）组、脑缺血再灌注（R）组、血塞通（P）组、右美托咪定（D）组，血塞通联合右美托咪定（PD）组，每组各10只。根据组别给予不同药物，行神经行为学测试；于第3、7天，测量脑梗死面积、脑水含量，以及超氧化物歧化酶（Superoxide dismutase，SOD）、谷胱甘肽过氧化酶（Glutathione peroxidase，GSH-PX）活性测定。结果   给药后第3、5、7天，与P、D组相比，PD组神经行为学评分改善更加显著（P＜0.001）；给药后第3、7天，与P组相比，PD组脑梗死面积、脑水含量均降低（P=0.01，P=0.002），SOD、GSH-PX活性升高显著（P=0.03，P=0.001）；与D组相比，PD组脑梗死面积、脑水含量也显著降低（P＜0.01，P=0.008）；SOD、GSH-PX活性升高显著（P=0.009，P＜0.001）。结论   血塞通联合右美托咪定较单独应用药物，能显著减轻缺血再灌注损伤造成的脑损害，具有脑保护作用。

       Objective  To explore the effects of Xuesaitong combined with dexmedetomidine on cerebral ischemia-reperfusion in elderly rats．Methods  Fifty elderly male Wistar rats were randomly divided into 5 groups：sham operation（C）group，cerebral ischemia-reperfusion（R）group，Xuesaitong（P）group，dexmedetomidine（D）group，Xuesaitong combined with dexmedetomidine（PD）group．Xuesaitong was given in group P，dexmedetomidine was given in group D，and normal saline was given in group C and group R，continuously for 7 days．After 3- and 7-day treatment，the brain of rats was dissected out to assay the area of cerebral infarction，degree of cerebral edema，superoxide dismutase（SOD） and glutathione peroxidase（GSH-PX） activity．Results  When compared PD group with P and D group，neurobehavioral score was lower at 3，5，7 day（P＜0.001）；area of cerebral infarction，degree of cerebral edema were less（P=0.01，P=0.002），activity of SOD and GSH-PX were higher at 3，7 days（P=0.03，P=0.001）respectively．When compared PD group with D group，area of cerebral infarction，degree of cerebral edema were less（P＜0.01，P=0.008），activity of SOD and GSH-PX were higher at 3，7 days（P=0.009，P＜0.001）respectively．Conclusions  The combination of Xuesaitong and dexmedetomidine can obviously reduce the damage by cerebral ischemia-reperfusion in elderly rats and has brain protective effects．