基于右美托咪定的阿片类药物节俭麻醉在电视辅助胸腔镜手术中的应用：一项随机对照试验。
完整摘要 · 中文译文
背景：右美托咪定因其镇痛特性和轻微的呼吸抑制作用，越来越多地被纳入视频辅助胸腔镜手术（VATS）期间减少阿片类药物用量的麻醉策略中。然而，右美托咪定仍与剂量相关的血流动力学不良反应有关，尤其是心动过缓和低血压。我们评估了在VATS期间，减少剂量的右美托咪定方案是否能在维持可接受的血流动力学安全性的同时减少术中阿片类药物需求量。 方法：在这项前瞻性随机对照试验中，68例接受VATS的患者被随机分配至右美托咪定组或对照组（每组34例）。右美托咪定组接受0.5 µg/kg的负荷剂量，随后在手术期间以0.5 µg/kg/h持续输注。对照组接受常规的芬太尼为基础麻醉。主要结局为维持期补救芬太尼消耗量。次要结局包括术后疼痛评分、术后恶心呕吐（PONV）、术后呼吸系统并发症以及围手术期安全性结局。 结果：右美托咪定组维持期补救芬太尼消耗量显著低于对照组（18.7 vs. 33.2 µg，P = 0.009）。两组间术后疼痛评分、补救镇痛需求、PONV及呼吸系统并发症相当。然而，右美托咪定组术中心动过缓发生率更高（23.5% vs. 0%，P = 0.005），且PAC期间术后低血压发生率更高 住院时间延长（23.5% 对 2.9%，P = 0.027）。这些血流动力学事件为一过性，并对药物干预有反应。 结论：以右美托咪定为基础阿片类药物节约型麻醉减少了VATS术中维持期补救性芬太尼给药。然而，这一减少幅度不大，未伴有明确的术后获益，并伴随心动过缓和低血压的增加。 试验注册：ClinicalTrials.gov（NCT05431322），于2022年6月14日注册。可访问 https://clinicaltrials.gov/study/NCT05431322 。
完整摘要 · 英文原文
BACKGROUND: Dexmedetomidine has increasingly been incorporated into opioid-sparing anesthetic strategies during video-assisted thoracoscopic surgery (VATS) because of its analgesic properties and minimal respiratory depression. However, dexmedetomidine remains associated with dose-related hemodynamic adverse effects, particularly bradycardia and hypotension. We evaluated whether a reduced-dose dexmedetomidine regimen decreases intraoperative opioid requirements while maintaining acceptable hemodynamic safety during VATS. METHODS: In this prospective randomized controlled trial, 68 patients undergoing VATS were randomly assigned to either a dexmedetomidine group or a control group (34 patients each). The dexmedetomidine group received a loading dose of 0.5 µg/kg followed by continuous infusion at 0.5 µg/kg/h during surgery. The control group received conventional fentanyl-based anesthesia. The primary outcome was maintenance-phase rescue fentanyl consumption. Secondary outcomes included postoperative pain scores, postoperative nausea and vomiting (PONV), postoperative respiratory complications, and perioperative safety outcomes. RESULTS: Maintenance-phase rescue fentanyl consumption was significantly lower in the dexmedetomidine group than in the control group (18.7 vs. 33.2 µg, P = 0.009). Postoperative pain scores, rescue analgesic requirements, PONV, and respiratory complications were comparable between groups. However, the dexmedetomidine group demonstrated a higher incidence of intraoperative bradycardia (23.5% vs. 0%, P = 0.005) and postoperative hypotension during PACU stay (23.5% vs. 2.9%, P = 0.027). These hemodynamic events were transient and responsive to pharmacologic intervention. CONCLUSIONS: Dexmedetomidine-based opioid-sparing anesthesia reduced maintenance-phase rescue fentanyl administration during VATS. However, the reduction was modest, was not associated with clear postoperative benefits, and was accompanied by increased bradycardia and hypotension. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05431322), registered on 14 June 2022. Available at https://clinicaltrials.gov/study/NCT05431322 .