右美托咪定的作用機制及其在門診麻醉中的應用_West China Medical Journal

Authors：

 侯伯軒 , 孫家潭

中國人民解放軍254醫院麻醉科（天津 300142）;

Corresponding?author：

Keywords：

α₂腎上腺素能受體激動劑; 右美托咪定; 門診麻醉

DOI：

10.7507/1002-0179.20150054

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新一代α₂腎上腺素能受體激動劑右美托咪定的受體選擇性遠高于第一代α₂腎上腺素能受體激動劑，減輕了對心血管系統的抑制，更好地發揮鎮靜、鎮痛、抗焦慮以及降低交感神經興奮性的作用。同時右美托咪定在體內分布迅速，清除半衰期較短，對呼吸幾乎無干擾作用，并能產生獨特的“可喚醒”鎮靜狀態。通過回顧右美托咪定的藥理作用、機制特點，以及近年來它在國內外門診麻醉中的應用，希望為實施門診麻醉提供一個新的思路。

Citation： 侯伯軒, 孫家潭. 右美托咪定的作用機制及其在門診麻醉中的應用. West China Medical Journal, 2015, 30(1): 179-182. doi: 10.7507/1002-0179.20150054 Copy

1.	?Cheung CW, Ng K, Liu J, et al. Analgesic and sedative effects of intranasal dexmedetomidine in third molar surgery under local anaesthesia[J]. Br J Anaesth, 2011, 107(3):430-437.
2.	詹銀周, 張興安, 邵偉棟, 等.右美托咪定在臂叢神經阻滯麻醉中的應用[J].中國新藥與臨床雜志, 2011, 30(4):272-274.
3.	Guo TZ, Jiang JY, Buttermann AE, et al. Dexmedetomidine injection into the locus ceruleus produces antinociception[J]. Anesthesiology, 1996, 84(4):873-881.
4.	Aracngeli A. D'Alo C, Gaspari R. Dexmedetomidine use in general anaesthesia[J]. Curr Drug Targets, 2009, 10(8):687-695.
5.	Bamgbade OA, Alfa JA. Dexmedetomidine anaesthesia for patients with obstructive sleep apnoea undergoing bariatric surgery[J]. Eur J Anaesthesiol, 2009, 26(2):176-177.
6.	Rutkowska K, Knapik P, Misiolek H. The effect of dexmedetomidine sedation on brachial plexus block in patients with end-stage renal disease[J]. Eur J Anaesthesiol, 2009, 26(10):851-855.
7.	Tan JA, Ho KM. Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients:a meta-analysis[J]. Intensive Care Med, 2010, 36(6):926-939.
8.	De Wolf AM, Fragen RJ, Avram MJ, et al. The pharmacokinetics of dexmedetomidine in volunteers with severe renal impairment[J]. Anesth Analg, 2001, 93(5):1205-1209.
9.	Bhana NL, Goa KL. Dexmedetomidine[J]. Reactions Weekly, 2008, 1211(1):12.
10.	Martin E, Ramsay G, Mantz J, et al. The role of theα₂-adrenoceptor agonist dexme-detomidine in postsurgical sedation in the intensive care unit[J]. J Intensive Care Med, 2003, 18(1):29-41.
11.	Nelson LE, Lu J, Guo T, et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects[J]. Anesthesiology, 2003, 98(2):428-436.
12.	Doze VA, Chen BX, Maze M. Dexmedetomidine produces a hypnotic-anesthetic action in rats via activation of central alpha-2 adrenoceptors[J]. Anesthesiology, 1989, 71(1):75-79.
13.	黃青青.右美托咪啶在重癥監護病房中的應用[J].中國危重病急救醫學, 2010, 22(10):578-580.
14.	Hall JE, Uhrich TD, Barney JA, et al. Sedative, amnestic, and analgesic properties of small2dose dexmedeto2 midine infusions[J]. Anesth Analg, 2000, 90(3):699-705.
15.	Lam SW, Alexander E. Dexmedetomidine use in criticalcare[J]. AACN Adv Crit Care, 2008, 19(1):113.
16.	Arain SR, Ruehlow RM, Uhrich TD, et al. The efficacy of dexmedetomidine versus morphine for postopertive analgesia after major inpatient surgery[J]. Anesth Analg, 2004, 98(1):153-158.
17.	He L, Xu JM, Dai RP. Dexmedetomidine reduces the incidence of fentanyl-induced cough:a double-blind, randomized, and placebo-controlled study[J]. Ups J Med Sci, 2012, 117(1):18-21.
18.	劉小南, 俞德梁, 趙青川, 等.關于日間手術模式的研究及應用進展[J].醫學與哲學, 2014, 35(4):56-59.
19.	趙素真.門診手術麻醉進展[J].臨床麻醉學雜志, 2003, 19(2):127-128.
20.	黃長爐, 江鶴群, 陳國忠, 等.小劑量右美托咪定持續泵注輔助頸叢阻滯的臨床觀察[J].臨床麻醉學雜志, 2011, 27(8):803-804.
21.	楊自娟, 張興安, 胡渤, 等.右美托咪定用于下肢手術鎮靜的適宜負荷劑量探討[J].中國藥房, 2013, 24(2):152-155.
22.	Muller S, Borowics SM, Fortis EA, et al. Clinical efficacy of dexmedetomidine alone is less than propofol for conscious sedation during ERCP[J]. Gastrointest Endosc, 2008, 67(4):651-659.
23.	Bergese SD, Candiotti KA, Bokesch PM, et al. A phaseⅢb, randomized, double-blind, placebo-controlled, multicenter study evaluating the safety and efficacy of dexmedetomidine for sedation during awake fiberoptic intubation[J]. Am J Ther, 2010, 17(6):586-595.
24.	Bergese SD, Patrick Bender S, Mcsweeney TD, et al. A comparative study of dexmedetomidine with midazolam and midazolam alone for sedation during elective awake fiberoptic intubation[J]. J Clin Anesth, 2010, 22(1):35-40.
25.	Wakita R, Kohase H, Fukayama H. A comparison of dexmedetomidine sedation with and without midazolam for dental implant surgery[J]. Anesth Prog, 2012, 59(2):62-68.
26.	Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans[J]. Anesthesiology, 2000, 93(2):382-394.
27.	Arain SR, Ebert TJ. The efficacy, side effect, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation[J]. Anesth Analg, 2002, 95(2):461-466.
28.	Ryu JH, Lee SW, Lee JH, et al. Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy[J]. Br J Anaesth, 2012, 108(3):503-511.
29.	張磊, 李倩, 葛亞麗, 等.右美托咪定復合丙泊酚在老年患者內鏡胰膽管造影術中的應用[J].臨床麻醉學雜志, 2013, 29(4):377-378.

1. ?Cheung CW, Ng K, Liu J, et al. Analgesic and sedative effects of intranasal dexmedetomidine in third molar surgery under local anaesthesia[J]. Br J Anaesth, 2011, 107(3):430-437.
2. 詹銀周, 張興安, 邵偉棟, 等.右美托咪定在臂叢神經阻滯麻醉中的應用[J].中國新藥與臨床雜志, 2011, 30(4):272-274.
3. Guo TZ, Jiang JY, Buttermann AE, et al. Dexmedetomidine injection into the locus ceruleus produces antinociception[J]. Anesthesiology, 1996, 84(4):873-881.
4. Aracngeli A. D'Alo C, Gaspari R. Dexmedetomidine use in general anaesthesia[J]. Curr Drug Targets, 2009, 10(8):687-695.
5. Bamgbade OA, Alfa JA. Dexmedetomidine anaesthesia for patients with obstructive sleep apnoea undergoing bariatric surgery[J]. Eur J Anaesthesiol, 2009, 26(2):176-177.
6. Rutkowska K, Knapik P, Misiolek H. The effect of dexmedetomidine sedation on brachial plexus block in patients with end-stage renal disease[J]. Eur J Anaesthesiol, 2009, 26(10):851-855.
7. Tan JA, Ho KM. Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients:a meta-analysis[J]. Intensive Care Med, 2010, 36(6):926-939.
8. De Wolf AM, Fragen RJ, Avram MJ, et al. The pharmacokinetics of dexmedetomidine in volunteers with severe renal impairment[J]. Anesth Analg, 2001, 93(5):1205-1209.
9. Bhana NL, Goa KL. Dexmedetomidine[J]. Reactions Weekly, 2008, 1211(1):12.
10. Martin E, Ramsay G, Mantz J, et al. The role of theα₂-adrenoceptor agonist dexme-detomidine in postsurgical sedation in the intensive care unit[J]. J Intensive Care Med, 2003, 18(1):29-41.
11. Nelson LE, Lu J, Guo T, et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects[J]. Anesthesiology, 2003, 98(2):428-436.
12. Doze VA, Chen BX, Maze M. Dexmedetomidine produces a hypnotic-anesthetic action in rats via activation of central alpha-2 adrenoceptors[J]. Anesthesiology, 1989, 71(1):75-79.
13. 黃青青.右美托咪啶在重癥監護病房中的應用[J].中國危重病急救醫學, 2010, 22(10):578-580.
14. Hall JE, Uhrich TD, Barney JA, et al. Sedative, amnestic, and analgesic properties of small2dose dexmedeto2 midine infusions[J]. Anesth Analg, 2000, 90(3):699-705.
15. Lam SW, Alexander E. Dexmedetomidine use in criticalcare[J]. AACN Adv Crit Care, 2008, 19(1):113.
16. Arain SR, Ruehlow RM, Uhrich TD, et al. The efficacy of dexmedetomidine versus morphine for postopertive analgesia after major inpatient surgery[J]. Anesth Analg, 2004, 98(1):153-158.
17. He L, Xu JM, Dai RP. Dexmedetomidine reduces the incidence of fentanyl-induced cough:a double-blind, randomized, and placebo-controlled study[J]. Ups J Med Sci, 2012, 117(1):18-21.
18. 劉小南, 俞德梁, 趙青川, 等.關于日間手術模式的研究及應用進展[J].醫學與哲學, 2014, 35(4):56-59.
19. 趙素真.門診手術麻醉進展[J].臨床麻醉學雜志, 2003, 19(2):127-128.
20. 黃長爐, 江鶴群, 陳國忠, 等.小劑量右美托咪定持續泵注輔助頸叢阻滯的臨床觀察[J].臨床麻醉學雜志, 2011, 27(8):803-804.
21. 楊自娟, 張興安, 胡渤, 等.右美托咪定用于下肢手術鎮靜的適宜負荷劑量探討[J].中國藥房, 2013, 24(2):152-155.
22. Muller S, Borowics SM, Fortis EA, et al. Clinical efficacy of dexmedetomidine alone is less than propofol for conscious sedation during ERCP[J]. Gastrointest Endosc, 2008, 67(4):651-659.
23. Bergese SD, Candiotti KA, Bokesch PM, et al. A phaseⅢb, randomized, double-blind, placebo-controlled, multicenter study evaluating the safety and efficacy of dexmedetomidine for sedation during awake fiberoptic intubation[J]. Am J Ther, 2010, 17(6):586-595.
24. Bergese SD, Patrick Bender S, Mcsweeney TD, et al. A comparative study of dexmedetomidine with midazolam and midazolam alone for sedation during elective awake fiberoptic intubation[J]. J Clin Anesth, 2010, 22(1):35-40.
25. Wakita R, Kohase H, Fukayama H. A comparison of dexmedetomidine sedation with and without midazolam for dental implant surgery[J]. Anesth Prog, 2012, 59(2):62-68.
26. Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans[J]. Anesthesiology, 2000, 93(2):382-394.
27. Arain SR, Ebert TJ. The efficacy, side effect, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation[J]. Anesth Analg, 2002, 95(2):461-466.
28. Ryu JH, Lee SW, Lee JH, et al. Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy[J]. Br J Anaesth, 2012, 108(3):503-511.
29. 張磊, 李倩, 葛亞麗, 等.右美托咪定復合丙泊酚在老年患者內鏡胰膽管造影術中的應用[J].臨床麻醉學雜志, 2013, 29(4):377-378.

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右美托咪定的作用機制及其在門診麻醉中的應用

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