右美托咪定用于腰—硬联合麻醉中的镇静效应
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摘要
随着医疗卫生事业的不断发展，麻醉医师不仅要不断提高麻醉水平，还需更新麻醉理念，为患者提供安全、舒适的麻醉。会阴、下腹部和下肢手术等低位手术中常选择腰-硬联合麻醉(CSEA)的麻醉方法，因为它能提供良好可靠的的麻醉效果，但它也有很多不足，例如无法很好的消除患者的紧张和焦虑情绪，还可能存在有不良记忆等缺点，患者在手术中处于清醒状态，难免使患者的恐惧和应激反应大大增加，进而对患者造成不利的因素从而使治疗效果受到影响而不够理想，所以常常需要我们在手术过程中给予适当的镇静治疗使患者更舒适使手术更趋人性化。合理地选择一种能使患者镇静、舒适、应激反应减少同时能保证呼吸循环系统的稳定的镇静药物具有非常重要的意义。右旋美托咪定（dexmedetomidine，D_EX）是一种新型、高效、高选择性的α2肾上腺素能受体激动剂，它具有镇痛、镇静和抗焦虑的作用，不仅能减少麻醉药物的用量,其不良反应也少，而且病人在腰硬联合麻醉过程中很容易被唤醒使之能及时的与医生沟通与配合，是目前手术麻醉过程中应用效果比较满意的镇静药物。
目的：观察并研究在腰-硬联合麻醉(CSEA)手术中分别应用不同剂量的右美托咪定时产生的相应的镇静效果，探究右美托咪定被应用于腰-硬联合麻醉过程中的适宜用药剂量和临床适用范围，为以后应用在临床时提供一定的参照。
方法：选择ASAⅠ~Ⅱ级，年龄在20~60岁，拟择期在腰-硬联合麻醉下实施手术的50例患者，随机平均分为右美托咪定镇静组(D_1组，D_2组，D_3组)、咪达唑仑镇静组（M组）和0.9%氯化钠注射液空白对照组(C组)五组，每组10人。D_1组（10例）受试者用微量输注泵在手术开始前10min内静脉泵注0.5μg/kg的右美托咪定预充负荷剂量,然后右美托咪定以恒速0.3μg/kg/h维持；D_2组（10例）受试者用微量输注泵在手术开始前10min内静脉泵注0.5μg/kg的右美托咪定预充负荷剂量,然后右美托咪定以恒速0.5μg/kg/h维持；D_3组（10例）受试者用微量输注泵在手术开始前10min内静脉泵注0.5μg/kg的右美托咪定预充负荷剂量,然后右美托咪定以恒速0.7μg/kg/h维持；M组（10例）受试者在手术开始前10min内用微量输注泵静脉泵入咪达唑仑0.05mg/kg，之后用微量输注泵按咪唑安定0.04mg/kg/h的剂量静脉泵入；C组（10例）用微量输注泵静脉泵入等容量0.9%氯化钠注射液。各组受试者停止微量输注泵注药的时间均选择在手术结束前15分钟时。观察并记录五组病人腰-硬联合麻醉后给药前(T_0)、给预充负荷量结束即刻(T_1)及预充负荷量后10min(T_2)、20min(T_3)、40min(T_4)、60min(T_5)的Ramsay评分、平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、脉搏血氧饱和度（SpO_2）和麻醉意识深度指数（CSI）。于术后随访24h，评估并记录患者对术中有关手术和麻醉过程的遗忘程度和对麻醉效果的满意程度。
结果：统计学处理采用SPSS13.0软件,计量资料采用均数士标准差(x±s)表示,采用重复测量资料的方差分析进行组内不同时点的比较,采用单因素方差分析进行组间比较，以P<0.05为差异有统计学意义。五组患者年龄、性别比、体重以及麻醉平面等的比较差异无统计学意义。给予右美托咪定后，D_1患者的平均动脉压、心率、呼吸频率变化不明显，Ramsay评分3分～4分，CSI值在右美托咪定负荷量后65～83; D_2组患者的平均动脉压、心率、呼吸频率出现轻微下降，Ramsay评分3分～5分，CSI值61～80；D_3组患者的平均动脉压、呼吸频率出现较轻微下降，心率在给予右美托咪定负荷量20min后有明显下降，其中有一例患者降至50次每分，给予阿托品0.5mg处理，Ramsay评分4分～6分，CSI值59～68；M组在给予咪达唑仑负荷量后平均动脉压、心率无明显变化，呼吸频率在给予咪达唑仑负荷量20min后明显受抑制，其中2例需要面罩吸氧加压辅助呼吸，Ramsay评分3分～5分，CSI值60～83。组间比较：T_3～T_5时D_1组、D_2组、D_3组、M组Ramsay评分显著高于C组（P<0.05)；T_3～T_5时D_1组、D_2组、D_3组、M组患者的平均动脉压、心率出现轻微下降；T_3～T_5时D_1组、D_2组、D_3组、M组患者的CSI显著低于C组。组内比较：T_3～T_5时D_1组、D_2组、D_3组和M组Ramsay评分显著高于T_0时（P<0.05)；T_3～T_5时D_1组、D_2组、D_3组、M组HR慢于T_0时,以D_3组减慢最为明显(P<0.05)；D_1组、D_2组、D_3组、M组患者T_3～T_5时RR均比T_0时有所减慢, M组减慢最为明显(P<0.05)；T_3～T_5时D_1组、D_2组、D_3组、M组患者的CSI明显低于T_0时（P<0.05）。其中D_3组几例患者在T_4后出现深度镇静且伴有明显的HR缓慢,1例患者需要使用阿托品。M组有2例呼吸抑制使SpO_2低至92%,通过辅助呼吸给氧使SpO_2逐渐恢复至98%以上。五组患者的血氧饱和度都基本维持在安全范围，比较无统计学意义。术后24h随访D_1组、D_2组、D_3组患者完全遗忘可度达50%～80%, D_1组、D_2组、D_3组、M组患者遗忘程度和麻醉满意程度均明显高于C组(P<0.05)。
结论：右旋美托咪定具有镇痛、抗焦虑作用，镇静效果理想，其抑制交感神经兴奋的作用能够为患者提供更稳定的血流动力学，而且对呼吸功能无明显的影响，是一种使病人容易被唤醒配合治疗而副作用少的镇静药物。腰硬联合麻醉的的手术前10min内泵注右美托咪定0.5μg/kg的负荷量，后以0.3～0.5μg/kg/h的速度静脉泵注能产生良好的镇静及维持效果、且无明显呼吸抑制作用、对血氧饱和度无影响，是适合各年龄段患者腰-硬联合麻醉的镇静用药浓度。
As medical technology continues to improve, not only requires theanesthesiologist to provide a comfortable, safe anesthesia, but also required tominimize the pain, and constantly improve the level of anesthesia updateanesthesia concept.Combined spinal-epidural anesthesia is the most commonlyused of the abdomen, perineum, lower limb surgery because of its irreplaceableadvantages, but it can not eliminate the patient's anxiety, tension, bad memoryand know and other shortcomings in the operation. Awake, fear and stressresponse caused invisible pressure and directly affect the therapeutic effect.Itsnecessary to give appropriate sedation to make the surgery more humanity andmake patients more comfortable. It has very important significance to choice adrug to made the patient calm and comfortable, reduce the stress response andmade respiratory and circulatory system maintain stable. Dexmedetomidinehydrochloride is a new type of high selective α2adrenergic receptoragonists,has analgesic, sedative and anxiolytic effects and can reduce theamount of anesthetic，has fewer adverse reactions. Patients during surgery caneasily be awakened and can communication with doctors. It is really an idealsedation drugs.
Objective To observe and study the sedative effect of different doses ofdexmede-tomidine given in patients with combined spinal-epidural anesthesia(CSEA). Explore dexmedetomidine given for CSEA sedation when appropriatedrug concentration and clinical safety, provide a reference for the clinicalapplication.
Methods Fifty patients, ASA Ⅰ~Ⅱ, aged20to60year s, scheduled forwith spinal-epidural anesthesia, were equally randomized into five groups:(n=10in each group): dexmedetomidine group(D_1D_2D_3), midazolam group (M) and blank control group (C). Ramsay score, mean arterial pressure (MAP),heart rate (HR), respiratory rate (RR), pulse oximetry (SpO_2) and the depth ofCerebral State Index (CSI) were recorded before anesthesia, after CSEA, and10,20,40and60min after sedative administration. All patients were followedup24hour postoperatively t o observe the amnestic effect during operation.
Results The heart rate, mean arterial blood pressure, respiratory rate ofgroup D_1patients did not change significantly; The heart rate, mean arterialpressure, respiratory rate of group D_2tended to reach the level of sedation;patients in group D_3with heart rate slow down significantly; respiratory rate ofpatients in group M is gradually reduced, including two cases of respiratorydepression; the heart rate, mean arterial pressure, respiratory rate group C didnot change significantly. Comparison between groups,Ramsay sedation scoreswere higher in D_1,D_2, D_3, M groups than C group at T_3～T_5(P<0.05). T_heheart rate, mean arterial blood pressure is slight decline in D_1,D_2, D_3, M groupsat T_3～T_5;CSI in D_1, D_2, D_3, M groups was significantly lower than in groupC. Heart rate decreased in D_3group than other groups at T_3～T_5(P<0.05).Ramsay sedation scores in D_1,D_2, D_3, M groups at T_3～T_5were higherthan T_0(P<0.05).Amnestic effects in dexmedetomidine groups were highercomparing to C group (P<0.05), while the difference was not statisticallysignificant comparing to M group.
Conclusion D_exmedetomidine0.5μg/kg followed by0.3～0.5μg/kg/hintravenous infusion caused effective sedation and amnestic effect duringoperation for patients with CSEA with no respiratory depression and cycleinhibition.
目的：观察并研究在腰-硬联合麻醉(CSEA)手术中分别应用不同剂量的右美托咪定时产生的相应的镇静效果，探究右美托咪定被应用于腰-硬联合麻醉过程中的适宜用药剂量和临床适用范围，为以后应用在临床时提供一定的参照。
方法：选择ASAⅠ~Ⅱ级，年龄在20~60岁，拟择期在腰-硬联合麻醉下实施手术的50例患者，随机平均分为右美托咪定镇静组(D_1组，D_2组，D_3组)、咪达唑仑镇静组（M组）和0.9%氯化钠注射液空白对照组(C组)五组，每组10人。D_1组（10例）受试者用微量输注泵在手术开始前10min内静脉泵注0.5μg/kg的右美托咪定预充负荷剂量,然后右美托咪定以恒速0.3μg/kg/h维持；D_2组（10例）受试者用微量输注泵在手术开始前10min内静脉泵注0.5μg/kg的右美托咪定预充负荷剂量,然后右美托咪定以恒速0.5μg/kg/h维持；D_3组（10例）受试者用微量输注泵在手术开始前10min内静脉泵注0.5μg/kg的右美托咪定预充负荷剂量,然后右美托咪定以恒速0.7μg/kg/h维持；M组（10例）受试者在手术开始前10min内用微量输注泵静脉泵入咪达唑仑0.05mg/kg，之后用微量输注泵按咪唑安定0.04mg/kg/h的剂量静脉泵入；C组（10例）用微量输注泵静脉泵入等容量0.9%氯化钠注射液。各组受试者停止微量输注泵注药的时间均选择在手术结束前15分钟时。观察并记录五组病人腰-硬联合麻醉后给药前(T_0)、给预充负荷量结束即刻(T_1)及预充负荷量后10min(T_2)、20min(T_3)、40min(T_4)、60min(T_5)的Ramsay评分、平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、脉搏血氧饱和度（SpO_2）和麻醉意识深度指数（CSI）。于术后随访24h，评估并记录患者对术中有关手术和麻醉过程的遗忘程度和对麻醉效果的满意程度。
结果：统计学处理采用SPSS13.0软件,计量资料采用均数士标准差(x±s)表示,采用重复测量资料的方差分析进行组内不同时点的比较,采用单因素方差分析进行组间比较，以P<0.05为差异有统计学意义。五组患者年龄、性别比、体重以及麻醉平面等的比较差异无统计学意义。给予右美托咪定后，D_1患者的平均动脉压、心率、呼吸频率变化不明显，Ramsay评分3分～4分，CSI值在右美托咪定负荷量后65～83; D_2组患者的平均动脉压、心率、呼吸频率出现轻微下降，Ramsay评分3分～5分，CSI值61～80；D_3组患者的平均动脉压、呼吸频率出现较轻微下降，心率在给予右美托咪定负荷量20min后有明显下降，其中有一例患者降至50次每分，给予阿托品0.5mg处理，Ramsay评分4分～6分，CSI值59～68；M组在给予咪达唑仑负荷量后平均动脉压、心率无明显变化，呼吸频率在给予咪达唑仑负荷量20min后明显受抑制，其中2例需要面罩吸氧加压辅助呼吸，Ramsay评分3分～5分，CSI值60～83。组间比较：T_3～T_5时D_1组、D_2组、D_3组、M组Ramsay评分显著高于C组（P<0.05)；T_3～T_5时D_1组、D_2组、D_3组、M组患者的平均动脉压、心率出现轻微下降；T_3～T_5时D_1组、D_2组、D_3组、M组患者的CSI显著低于C组。组内比较：T_3～T_5时D_1组、D_2组、D_3组和M组Ramsay评分显著高于T_0时（P<0.05)；T_3～T_5时D_1组、D_2组、D_3组、M组HR慢于T_0时,以D_3组减慢最为明显(P<0.05)；D_1组、D_2组、D_3组、M组患者T_3～T_5时RR均比T_0时有所减慢, M组减慢最为明显(P<0.05)；T_3～T_5时D_1组、D_2组、D_3组、M组患者的CSI明显低于T_0时（P<0.05）。其中D_3组几例患者在T_4后出现深度镇静且伴有明显的HR缓慢,1例患者需要使用阿托品。M组有2例呼吸抑制使SpO_2低至92%,通过辅助呼吸给氧使SpO_2逐渐恢复至98%以上。五组患者的血氧饱和度都基本维持在安全范围，比较无统计学意义。术后24h随访D_1组、D_2组、D_3组患者完全遗忘可度达50%～80%, D_1组、D_2组、D_3组、M组患者遗忘程度和麻醉满意程度均明显高于C组(P<0.05)。
结论：右旋美托咪定具有镇痛、抗焦虑作用，镇静效果理想，其抑制交感神经兴奋的作用能够为患者提供更稳定的血流动力学，而且对呼吸功能无明显的影响，是一种使病人容易被唤醒配合治疗而副作用少的镇静药物。腰硬联合麻醉的的手术前10min内泵注右美托咪定0.5μg/kg的负荷量，后以0.3～0.5μg/kg/h的速度静脉泵注能产生良好的镇静及维持效果、且无明显呼吸抑制作用、对血氧饱和度无影响，是适合各年龄段患者腰-硬联合麻醉的镇静用药浓度。
As medical technology continues to improve, not only requires theanesthesiologist to provide a comfortable, safe anesthesia, but also required tominimize the pain, and constantly improve the level of anesthesia updateanesthesia concept.Combined spinal-epidural anesthesia is the most commonlyused of the abdomen, perineum, lower limb surgery because of its irreplaceableadvantages, but it can not eliminate the patient's anxiety, tension, bad memoryand know and other shortcomings in the operation. Awake, fear and stressresponse caused invisible pressure and directly affect the therapeutic effect.Itsnecessary to give appropriate sedation to make the surgery more humanity andmake patients more comfortable. It has very important significance to choice adrug to made the patient calm and comfortable, reduce the stress response andmade respiratory and circulatory system maintain stable. Dexmedetomidinehydrochloride is a new type of high selective α2adrenergic receptoragonists,has analgesic, sedative and anxiolytic effects and can reduce theamount of anesthetic，has fewer adverse reactions. Patients during surgery caneasily be awakened and can communication with doctors. It is really an idealsedation drugs.
Objective To observe and study the sedative effect of different doses ofdexmede-tomidine given in patients with combined spinal-epidural anesthesia(CSEA). Explore dexmedetomidine given for CSEA sedation when appropriatedrug concentration and clinical safety, provide a reference for the clinicalapplication.
Methods Fifty patients, ASA Ⅰ~Ⅱ, aged20to60year s, scheduled forwith spinal-epidural anesthesia, were equally randomized into five groups:(n=10in each group): dexmedetomidine group(D_1D_2D_3), midazolam group (M) and blank control group (C). Ramsay score, mean arterial pressure (MAP),heart rate (HR), respiratory rate (RR), pulse oximetry (SpO_2) and the depth ofCerebral State Index (CSI) were recorded before anesthesia, after CSEA, and10,20,40and60min after sedative administration. All patients were followedup24hour postoperatively t o observe the amnestic effect during operation.
Results The heart rate, mean arterial blood pressure, respiratory rate ofgroup D_1patients did not change significantly; The heart rate, mean arterialpressure, respiratory rate of group D_2tended to reach the level of sedation;patients in group D_3with heart rate slow down significantly; respiratory rate ofpatients in group M is gradually reduced, including two cases of respiratorydepression; the heart rate, mean arterial pressure, respiratory rate group C didnot change significantly. Comparison between groups,Ramsay sedation scoreswere higher in D_1,D_2, D_3, M groups than C group at T_3～T_5(P<0.05). T_heheart rate, mean arterial blood pressure is slight decline in D_1,D_2, D_3, M groupsat T_3～T_5;CSI in D_1, D_2, D_3, M groups was significantly lower than in groupC. Heart rate decreased in D_3group than other groups at T_3～T_5(P<0.05).Ramsay sedation scores in D_1,D_2, D_3, M groups at T_3～T_5were higherthan T_0(P<0.05).Amnestic effects in dexmedetomidine groups were highercomparing to C group (P<0.05), while the difference was not statisticallysignificant comparing to M group.
Conclusion D_exmedetomidine0.5μg/kg followed by0.3～0.5μg/kg/hintravenous infusion caused effective sedation and amnestic effect duringoperation for patients with CSEA with no respiratory depression and cycleinhibition.
引文
[1] Khan ZP, Ferguson CN, Jones RM. Alpha-2and imidazoline receptoragonists:their pharmacology and therapeutic role.Anesthesia,1999,54:146-165.
[2] Calzada BC, De Artinano AA.[alpha]2-Adrenorecep tor subtypes[J].Pharm acol Res,2001;44:195-208.
[3] DE WOLF A M, FRAGEN R J, AVRAM M J, et al. T hepharmacokinetics of dexmedetomidine in volunteers with severerenalimpairment [J]. Anesthesia&Analgesia,2001,93(5):1205-1209.
[4] Samia-ElbaradieMD, Dexmedetomidin e VS. Pm pofol for short-termsedation of postoperative mechanically ventilated patients [J]. CancerInst,2004,16:153-158.
[5] Bhana N, Goa KL, McClellan K. Dexmedetomidine [J]. Drugs,2000,59(2):2632268.
[6] MazeM, Scarfini C, Cavaliere F. New agents for sedation in the intensivecare unit[J]. Crit Care Clin,2001,17(4):8812897.
[7] Correa-Sales C, Rab in BC, MazeM. A hypnotic response todexmedetomidine, an α2agonist, is mediated in the locus coeruleus inrats[J]. Anesthesiology,1992,76:948-952.
[8] Christiane Correa-Sales. A Hypotic response to Dexmedetomidine, an αagonist,is mediated in the Locus Corruleus in rats.Anesthesiology,1992,76:948.
[9]史中华,周建新右美托嘧啶在危重患者中的应用[J]麻醉与监护论坛,2007,14(5):327-329.
[10]Ebert TJ, Hall JE, Barney JA, et al. The effects of increase plasmaconcentration of dexmedetomidine in humans.Anesthesiology,2000,93:382.
[11]Hall JE, Uhrich TD, Barney JA, et al. Sedative, amnestic, and analgesicproperties of small-dose dexmedetomidine infusions.Anesth Analg,2000,90:699-705.
[12]Ruotsalainen S, Haapalinna A, Riekkinen PJSr, et al. Dexmedetomidinereduces reponse tendency,but not accuracy of rats in attention and short-term memory tasks. Pharmacol Biochem Behav,1997,56:31-40.
[13]BhanaN,GoaKL, McClellan K. Dexmedetomidine.Drugs,2000,59:263-268.
[14]Hunter JC, FontanaDJ, HedleyLR, et al. Assessment of the role of al2pha2-adrenocep tor subtypes in the anti nociceptive, sedative andhy2pothermic action of dexmedetomidine in transgenic mice [J]. B rJPharmacol,1997;122:1339-1344.
[15]Nelson LE,Lu J, Guo TZ, et al. Theα2-Adrenocep tor agonist detomidineconverges on an endogenous sleep-promoting pathway to exertitssedative effects [J]. Anesthesiology,2003;98:428-436.
[16]Coull JT, JonesM, Egan T, et al. Attentional effects of nor adrenaline varywith arousal level: selective activation of thalamic pulvinar in humans[J].N euro Im age,2004;22:315-322.
[17]HUBBARD RC, NAUMANN TM, TRAYLOR L, et al. Parecoxib sodiumhas opioidsparing effects in patients undergoing total knee arthrop lastyunder spin al an aesthesia[J]. Br J Anaesth,2003,90(2):166-172.
[18]GROSS JB, JEFFREY B. Parecoxib sod ium, a paren teralcyclooxygenase2selective inh ib itor, im proves morph ine ana lges ia andis op ioid sparing following total hiparthroplasty[J]. Surv An esthesiol,2004,48(2):99-100.
[19]W ILLIGERS H M, PRINZEN F W, ROEKAERTS P M, etal.Dexmedetom idine decreases perio perative myocardial lactatere lease indogs [J]. AnesthAnalg,2003,96(5):657-664.
[20]Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasmaconcentrations of dexmedetomidine in humans [J]. Anesthesiology,2000;93:382-394.
[21]RamseyMA, Luterman DL. Dexmedetomidine as a total intravenousanesthestic agent [J]. Anesthesiology,2004;101:787–781
[22]Talke P, Chen R, ThomasB, et al. The hemodynamic and adrenergic effectsof perioperative dexmedetomidine infusion after vascular surgery[J].Anesth Analg,2000;90:834-839.
[23]Venn RM, Bryant A, Hall GM, et al. Effects of dexmedetomidine onadrenocortical function, and cardiovascular, endocrine and inflammato2ryresponses in postoperative patients needing sedation in the intensivecareunit [J]. B r J Anaesth,2001;86:650-656.
[24]Tobias JD. Demedetomidine: applications in pediateic critical care andpediatric anesthesiology [J]. Pediatric Critical Care Medicine,2007,8(2):115-131.
[25]Bicer C, Esmaoglu A, Akin A, et al. Dexmedetomidine and meperidineprevent postanaesthetic shivering. Eur J Anaesthesiol,2006,23:149-153.
[26]Aho M, Scheinin M, Lehtinen AM, et al. Intramuscularly administereddexmedetomidine attenuates hemodynamic and stress hormone responsesto gynecologic laparoscopy.Anesth Analg,1992,75:932-939.
[27]Taittonen MT, Kirvela OA, Aantaa R, et al. Effect of clonidine anddexmedetomidine premidication on perioperative oxygen consumptionand haemodynamic state.Br J Anaedth,1997,78:400-406.
[28]Khan ZP, Munday IT, Jones RM, et al. Effects of dexmedetomidine onisoflurane require-ments in healthy volunteers.1:pharmacodynamic andpharmacokinetic interactions. Br J Anesth,1999,83:372-380.
[29]Robert JF, Paul CF, BSN, MS. Effect of dexmedetomidine on theminimum alveolar concentration (MAC) of sevoflurane in adults age55to70years. J Clin Anesth,1999,11:466-470.
[30]Maze M, Virtanen R, Daunt D, et al. Effects of dexmedetomidine, a novelmidazole sedative-anesthetic agent, on adrenal steroidogenesis:in vivo andin vitro studies.Anesth Analg,1991,73:204-208.
[31]Hall E, Uhrich T, Barney J, etal. Sedative, amnestic, and analgesicproperties of small dexmedetomidine infusions. Anesth Analg,2000,90:699-705.
[32]Keira PM, Steven EZ, Jennifer LD, et al. Dexmedetomidine for pediatricsedation for computed tomography imaging studies.Anesth Analg,2006,103:57-62.
[33]Berkenstadt H, Perel A, Hadani M, et al. Monitored anesthesia care usingremifentanil and propofol for awake craniotomy. JNeurosurgAnesthesiol,2001,13:246-250
[34]Vinik HR, Bradley EL, Kissin JL. Comparison of midazolam dose-response curves for amnesia and hypnosis. Anesthesioolgy,1992,77(No3A): A207.
[35]陈伯銮.临床麻醉药理学.人民卫生出版社,2000:92.
[36]Yildiz M， Tavlan A， Tuncer S， et al． Effects of dexmedetomidine onhaemodynamic responses to laryngoscopy and intubation：periopertivehaemodynamic and anesthestic requirments[J]．Drugs，2006，7（1）：43-52．
[37]Disma N, lauretta D, Patemia F. Level of sedation evalution with cerebralstate index and A2L in Arx in children under2going diagnostic procedures[J]. Peditric Anesthesia,2007,17(3):445-451.
[38]Anderson RE, Jakobsson JG. Cerebral state index response to incision: aclinical study in day surgical patients[J]. Ac2ta Anaesthesiol Scand,2006,50(6):749-753.
[1]Rams ay MA, SavegeTM, Simpson BR, et al. Cont rolled sedation withalphaxal on e alphadolne. Br Med J,1974,22:656-659.
[2]张建蓉,贾小林,孔嘉麟.咪唑安定作为硬膜外阻滞前用药时间的探讨.临床麻醉学杂志,2004,20:488-489.
[3]毛剑霞,许靖.腰麻-硬膜外联合麻醉在老年患者的应用.临床麻醉学杂志,2009,25:359.
[4]刘玲，纪风涛，刘付宁，梁建军，曹铭辉.右美托咪定对老年患者腰-硬联合麻醉的镇静效应.临床麻醉学杂志,2011，27：49-51
[5]中华医学会重症医学分会, Society of Critical Care Medicine CMA.中国重症加强治疗病房患者镇痛和镇静治疗指导意见（2006）[J].中华外科杂志,2006,44(17):1158-66
[6]ArainSR, Ebert TJ. T he efficacy, side effects, and recovery characteristicsof dexmedetomidine versus propofol when used for intraoperative sedation.Anesth Analg,2002,95:461-466.
[7]Dere K, Sucul lu I, Budak ET, etal. A comparison of dexmedetomidineversus midazolam for sedation, pain and hemodynamic control, duringcolonoscopy under conscious sedation.Eur J Anaesth esiol,2010,27:648-652.
[8]张燕,郑利民.右美托咪咤的药理作用及临床应用进展[J].国际麻醉学与复苏杂志,2007,28(6):544-7.
[9]Raekallio MR, Kuusela EK, Lehtinen ME, etal. Effect s of exercise inducedstress and dexamethas one on plasma hormone and glucose concentrationsand sedation in dogs treated with dexmedetomidine. Am J Vet Res,2005,66:260-265.
[10]Khan ZP, Fergus on CN, J ones RM. Alpha2and midazoline receptoragonist: their pharmacology and therapeutic role. Anesthesia,1999,54:146-165.
[11]李民,张利萍,吴新民.右美托咪啶在临床麻醉中应用的研究进展[J].中国临床药理学杂志,2007,23(6):466-70.
[12]Al-Mustafa MM, Badran IZ, Abu-Ali HM, et al. Intravenousdexmedetomidine prolongs bupivacaine spinal analgesia[J]. MEJAnesth,2009,20(2):225-31.
[13]Hall JE, U hrich TD, Barney JA, et al. Sedative, amnestic,and analgesicproperties of small dose dexmedetomidine infusions. Anesth Anal g,2000,90:699-705.
[2] Calzada BC, De Artinano AA.[alpha]2-Adrenorecep tor subtypes[J].Pharm acol Res,2001;44:195-208.
[3] DE WOLF A M, FRAGEN R J, AVRAM M J, et al. T hepharmacokinetics of dexmedetomidine in volunteers with severerenalimpairment [J]. Anesthesia&Analgesia,2001,93(5):1205-1209.
[4] Samia-ElbaradieMD, Dexmedetomidin e VS. Pm pofol for short-termsedation of postoperative mechanically ventilated patients [J]. CancerInst,2004,16:153-158.
[5] Bhana N, Goa KL, McClellan K. Dexmedetomidine [J]. Drugs,2000,59(2):2632268.
[6] MazeM, Scarfini C, Cavaliere F. New agents for sedation in the intensivecare unit[J]. Crit Care Clin,2001,17(4):8812897.
[7] Correa-Sales C, Rab in BC, MazeM. A hypnotic response todexmedetomidine, an α2agonist, is mediated in the locus coeruleus inrats[J]. Anesthesiology,1992,76:948-952.
[8] Christiane Correa-Sales. A Hypotic response to Dexmedetomidine, an αagonist,is mediated in the Locus Corruleus in rats.Anesthesiology,1992,76:948.
[9]史中华,周建新右美托嘧啶在危重患者中的应用[J]麻醉与监护论坛,2007,14(5):327-329.
[10]Ebert TJ, Hall JE, Barney JA, et al. The effects of increase plasmaconcentration of dexmedetomidine in humans.Anesthesiology,2000,93:382.
[11]Hall JE, Uhrich TD, Barney JA, et al. Sedative, amnestic, and analgesicproperties of small-dose dexmedetomidine infusions.Anesth Analg,2000,90:699-705.
[12]Ruotsalainen S, Haapalinna A, Riekkinen PJSr, et al. Dexmedetomidinereduces reponse tendency,but not accuracy of rats in attention and short-term memory tasks. Pharmacol Biochem Behav,1997,56:31-40.
[13]BhanaN,GoaKL, McClellan K. Dexmedetomidine.Drugs,2000,59:263-268.
[14]Hunter JC, FontanaDJ, HedleyLR, et al. Assessment of the role of al2pha2-adrenocep tor subtypes in the anti nociceptive, sedative andhy2pothermic action of dexmedetomidine in transgenic mice [J]. B rJPharmacol,1997;122:1339-1344.
[15]Nelson LE,Lu J, Guo TZ, et al. Theα2-Adrenocep tor agonist detomidineconverges on an endogenous sleep-promoting pathway to exertitssedative effects [J]. Anesthesiology,2003;98:428-436.
[16]Coull JT, JonesM, Egan T, et al. Attentional effects of nor adrenaline varywith arousal level: selective activation of thalamic pulvinar in humans[J].N euro Im age,2004;22:315-322.
[17]HUBBARD RC, NAUMANN TM, TRAYLOR L, et al. Parecoxib sodiumhas opioidsparing effects in patients undergoing total knee arthrop lastyunder spin al an aesthesia[J]. Br J Anaesth,2003,90(2):166-172.
[18]GROSS JB, JEFFREY B. Parecoxib sod ium, a paren teralcyclooxygenase2selective inh ib itor, im proves morph ine ana lges ia andis op ioid sparing following total hiparthroplasty[J]. Surv An esthesiol,2004,48(2):99-100.
[19]W ILLIGERS H M, PRINZEN F W, ROEKAERTS P M, etal.Dexmedetom idine decreases perio perative myocardial lactatere lease indogs [J]. AnesthAnalg,2003,96(5):657-664.
[20]Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasmaconcentrations of dexmedetomidine in humans [J]. Anesthesiology,2000;93:382-394.
[21]RamseyMA, Luterman DL. Dexmedetomidine as a total intravenousanesthestic agent [J]. Anesthesiology,2004;101:787–781
[22]Talke P, Chen R, ThomasB, et al. The hemodynamic and adrenergic effectsof perioperative dexmedetomidine infusion after vascular surgery[J].Anesth Analg,2000;90:834-839.
[23]Venn RM, Bryant A, Hall GM, et al. Effects of dexmedetomidine onadrenocortical function, and cardiovascular, endocrine and inflammato2ryresponses in postoperative patients needing sedation in the intensivecareunit [J]. B r J Anaesth,2001;86:650-656.
[24]Tobias JD. Demedetomidine: applications in pediateic critical care andpediatric anesthesiology [J]. Pediatric Critical Care Medicine,2007,8(2):115-131.
[25]Bicer C, Esmaoglu A, Akin A, et al. Dexmedetomidine and meperidineprevent postanaesthetic shivering. Eur J Anaesthesiol,2006,23:149-153.
[26]Aho M, Scheinin M, Lehtinen AM, et al. Intramuscularly administereddexmedetomidine attenuates hemodynamic and stress hormone responsesto gynecologic laparoscopy.Anesth Analg,1992,75:932-939.
[27]Taittonen MT, Kirvela OA, Aantaa R, et al. Effect of clonidine anddexmedetomidine premidication on perioperative oxygen consumptionand haemodynamic state.Br J Anaedth,1997,78:400-406.
[28]Khan ZP, Munday IT, Jones RM, et al. Effects of dexmedetomidine onisoflurane require-ments in healthy volunteers.1:pharmacodynamic andpharmacokinetic interactions. Br J Anesth,1999,83:372-380.
[29]Robert JF, Paul CF, BSN, MS. Effect of dexmedetomidine on theminimum alveolar concentration (MAC) of sevoflurane in adults age55to70years. J Clin Anesth,1999,11:466-470.
[30]Maze M, Virtanen R, Daunt D, et al. Effects of dexmedetomidine, a novelmidazole sedative-anesthetic agent, on adrenal steroidogenesis:in vivo andin vitro studies.Anesth Analg,1991,73:204-208.
[31]Hall E, Uhrich T, Barney J, etal. Sedative, amnestic, and analgesicproperties of small dexmedetomidine infusions. Anesth Analg,2000,90:699-705.
[32]Keira PM, Steven EZ, Jennifer LD, et al. Dexmedetomidine for pediatricsedation for computed tomography imaging studies.Anesth Analg,2006,103:57-62.
[33]Berkenstadt H, Perel A, Hadani M, et al. Monitored anesthesia care usingremifentanil and propofol for awake craniotomy. JNeurosurgAnesthesiol,2001,13:246-250
[34]Vinik HR, Bradley EL, Kissin JL. Comparison of midazolam dose-response curves for amnesia and hypnosis. Anesthesioolgy,1992,77(No3A): A207.
[35]陈伯銮.临床麻醉药理学.人民卫生出版社,2000:92.
[36]Yildiz M， Tavlan A， Tuncer S， et al． Effects of dexmedetomidine onhaemodynamic responses to laryngoscopy and intubation：periopertivehaemodynamic and anesthestic requirments[J]．Drugs，2006，7（1）：43-52．
[37]Disma N, lauretta D, Patemia F. Level of sedation evalution with cerebralstate index and A2L in Arx in children under2going diagnostic procedures[J]. Peditric Anesthesia,2007,17(3):445-451.
[38]Anderson RE, Jakobsson JG. Cerebral state index response to incision: aclinical study in day surgical patients[J]. Ac2ta Anaesthesiol Scand,2006,50(6):749-753.
[1]Rams ay MA, SavegeTM, Simpson BR, et al. Cont rolled sedation withalphaxal on e alphadolne. Br Med J,1974,22:656-659.
[2]张建蓉,贾小林,孔嘉麟.咪唑安定作为硬膜外阻滞前用药时间的探讨.临床麻醉学杂志,2004,20:488-489.
[3]毛剑霞,许靖.腰麻-硬膜外联合麻醉在老年患者的应用.临床麻醉学杂志,2009,25:359.
[4]刘玲，纪风涛，刘付宁，梁建军，曹铭辉.右美托咪定对老年患者腰-硬联合麻醉的镇静效应.临床麻醉学杂志,2011，27：49-51
[5]中华医学会重症医学分会, Society of Critical Care Medicine CMA.中国重症加强治疗病房患者镇痛和镇静治疗指导意见（2006）[J].中华外科杂志,2006,44(17):1158-66
[6]ArainSR, Ebert TJ. T he efficacy, side effects, and recovery characteristicsof dexmedetomidine versus propofol when used for intraoperative sedation.Anesth Analg,2002,95:461-466.
[7]Dere K, Sucul lu I, Budak ET, etal. A comparison of dexmedetomidineversus midazolam for sedation, pain and hemodynamic control, duringcolonoscopy under conscious sedation.Eur J Anaesth esiol,2010,27:648-652.
[8]张燕,郑利民.右美托咪咤的药理作用及临床应用进展[J].国际麻醉学与复苏杂志,2007,28(6):544-7.
[9]Raekallio MR, Kuusela EK, Lehtinen ME, etal. Effect s of exercise inducedstress and dexamethas one on plasma hormone and glucose concentrationsand sedation in dogs treated with dexmedetomidine. Am J Vet Res,2005,66:260-265.
[10]Khan ZP, Fergus on CN, J ones RM. Alpha2and midazoline receptoragonist: their pharmacology and therapeutic role. Anesthesia,1999,54:146-165.
[11]李民,张利萍,吴新民.右美托咪啶在临床麻醉中应用的研究进展[J].中国临床药理学杂志,2007,23(6):466-70.
[12]Al-Mustafa MM, Badran IZ, Abu-Ali HM, et al. Intravenousdexmedetomidine prolongs bupivacaine spinal analgesia[J]. MEJAnesth,2009,20(2):225-31.
[13]Hall JE, U hrich TD, Barney JA, et al. Sedative, amnestic,and analgesicproperties of small dose dexmedetomidine infusions. Anesth Anal g,2000,90:699-705.
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