摘要目的:评价盐酸右美托咪定在B超引导下肝癌微波消融术中静脉麻醉的效果。方法:本研究为前瞻性研究，选取2015年9月至2017年1月河北医科大学第四医院肝胆外科收治的148例择期行B超引导下肝癌微波消融术患者，男82例，女66例，年龄(58.1±4.6)岁，年龄范围为53~66岁。采用随机数表法将患者随机分为盐酸右美托咪定复合瑞芬太尼组(右美托咪定组)和丙泊酚复合瑞芬太尼组(丙泊酚组)，每组74例。右美托咪定组术前微量泵入盐酸右美托咪定。丙泊酚组术前以Marsh模型血浆靶控输注丙泊酚。记录手术时间、苏醒时间、术中疼痛程度、术者的满意度评分、视觉模拟评分(VAS)情况、不良反应，以及患者入室时(T0)、穿刺时(T1)、微波消融开始即刻(T2)、微波消融结束退针时(T3)、术后30 min(T4)的平均动脉压(MAP)和心率。结果:右美托咪定组手术时间[(27.82±2.21)min]明显短于丙泊酚组[(44.44±3.19)min]，苏醒时间[(6.02±1.81)min]早于丙泊酚组[(11.84±1.85)min]，差异均有统计学意义( P<0.05)。右美托咪定组术中疼痛程度明显优于丙泊酚组，术者对右美托咪定组满意度评分优于丙泊酚组，差异均有统计学意义( P<0.05) 。右美托咪定组在T2、T3时间点的MAP[(92.8±2.8)mmHg、(90.6±2.2)mmHg，1 mmHg＝0.133 kPa]均低于丙泊酚组[(102.6±3.4)mmHg、(99.2±3.8)mmHg]，差异有统计学意义( P<0.05)。右美托咪定组在T1、T2、T3、T4时间点的心率[(61.4±2.3)次/分、(61.2±2.2)次/分、(59.8±3.6)次/分、(61.6±4.2)次/分]均低于丙泊酚组[(80.6±3.0)次/分、(90.0±3.1)次/分、(87.6±3.0)次/分、(79.4±1.3)次/分]，差异有统计学意义( P<0.05)。右美托咪定组患者在术后2、4 h的VAS评分[(1.62±0.10)分、(1.92±0.17)分]明显低于丙泊酚组[(2.93±0.12)分、(3.04±0.24)分]，差异有统计学意义( P<0.05)。右美托咪定组恶心呕吐、呼吸抑制、术中体动发生率(14.9%、0、6.8%)均低于丙泊酚组(36.5%、4.1%、60.8%)，差异均有统计学意义( P<0.05)。 结论:右美托咪定更适用于B超引导下肝癌微波消融术要求清醒镇静的麻醉管理。

abstractsObjective:To evaluate the efficacy of dexmedetomidine in intravenous anesthesia for microwave ablation of hepatocellular carcinoma guided by B ultrasound.Methods:In this prospective study, a total of 148 patients, who underwent microwave ablation of hepatocellular carcinoma guided by B ultrasound, including 82 males and 66 females, aged(58.1±4.6)years, ranging from 53 to 66 years, were selected from September 2015 to January 2017 in the department of hepatobiliary Surgery, the Fourth Hospital of Hebei Medical University.Patients were randomly divided into dexmedetomidine hydrochloride combined remifentanil group(dexmedetomidine group)and propofol combined remifentanil group(propofol group)by random number table method, 74 cases in each group.Patients in the dexmedetomidine group was micropumped with dexmedetomidine hydrochloride before surgery.In the propofol group, Marsh model plasma target controlled infusion of propofol was used.Operation time, recovery time, intraoperative pain degree, surgeon′s satisfaction score, visual analog scale(VAS)score and adverse reactions and mean arterial pressure(MAP)and heart rate at the time of entry(T0), puncture(T1), immediately after microwave ablation(T2), needle withdrawal(T3), and 30 min after surgery(T4)were recorded.Results:The operation time of dexmedetomidine group[(27.82±2.21)min]was significantly shorter than that of propofol group[(44.44±3.19)min], and the recovery time of dexmedetomidine group[(6.02±1.81)min]was earlier than that of propofol group[(11.84±1.85)min], with statistically significant differences( P<0.05).Intraoperative pain degree in the dexmedetomidine group were significantly better than that in the propofol group, and surgeon′s satisfaction score in the dexmedetomidine group was better than that in the propofol group, with statistical significance( P<0.05).MAP at T2 and T3 of dexmedetomidine group[(92.8±2.8)mmHg, (90.6±2.2)mmHg]were lower than those in the propofol group[(102.6±3.4)mmHg, (99.2±3.8)mmHg], the difference was statistically significant( P<0.05).HP in dexmedetomidine group at T1, T2, T3 and T4 time points[(61.4±2.3)times /min, (61.2±2.2)times /min, (59.8±3.6)times /min, (61.6±4.2)times /min]were lower than those in the propofol group[(80.6±3.0)times /min, (90.0±3.1)times /min, (87.6±3.0)times /min, (79.4±1.3)times /min], the difference was statistically significant( P<0.05).VAS scores at 2 and 4 h after surgery in dexmedetomidine group[(1.62±0.10)points, (1.92±0.17)points]were significantly lower than those in the propofol group[(2.93±0.12)points, (3.04±0.24)points], and the difference was statistically significant( P<0.05).The incidence of nausea and vomiting, respiratory depression and intraoperative movement in dexmedetomidine group(14.9%, 0, 6.8%)were lower than those in the propofol group(36.5%, 4.1%, 60.8%), the differences were statistically significant( P<0.05). Conclusions:Dexmedetomidine is more suitable for the anesthesia management of microwave ablation of hepatocellular carcinoma requiring awake sedation under the guidance of B ultrasound.