右美托咪定的作用机制及其在门诊麻醉中的应用_West China Medical Journal

Authors：

 侯伯轩 , 孙家潭

中国人民解放军254医院麻醉科（天津 300142）;

Corresponding author：

Keywords：

α₂肾上腺素能受体激动剂; 右美托咪定; 门诊麻醉

DOI：

10.7507/1002-0179.20150054

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新一代α₂肾上腺素能受体激动剂右美托咪定的受体选择性远高于第一代α₂肾上腺素能受体激动剂，减轻了对心血管系统的抑制，更好地发挥镇静、镇痛、抗焦虑以及降低交感神经兴奋性的作用。同时右美托咪定在体内分布迅速，清除半衰期较短，对呼吸几乎无干扰作用，并能产生独特的“可唤醒”镇静状态。通过回顾右美托咪定的药理作用、机制特点，以及近年来它在国内外门诊麻醉中的应用，希望为实施门诊麻醉提供一个新的思路。

Citation： 侯伯轩, 孙家潭. 右美托咪定的作用机制及其在门诊麻醉中的应用. 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.	詹银周, 张兴安, 邵伟栋, 等.右美托咪定在臂丛神经阻滞麻醉中的应用[J].中国新药与临床杂志, 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.	黄青青.右美托咪啶在重症监护病房中的应用[J].中国危重病急救医学, 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.	刘小南, 俞德梁, 赵青川, 等.关于日间手术模式的研究及应用进展[J].医学与哲学, 2014, 35(4):56-59.
19.	赵素真.门诊手术麻醉进展[J].临床麻醉学杂志, 2003, 19(2):127-128.
20.	黄长炉, 江鹤群, 陈国忠, 等.小剂量右美托咪定持续泵注辅助颈丛阻滞的临床观察[J].临床麻醉学杂志, 2011, 27(8):803-804.
21.	杨自娟, 张兴安, 胡渤, 等.右美托咪定用于下肢手术镇静的适宜负荷剂量探讨[J].中国药房, 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.	张磊, 李倩, 葛亚丽, 等.右美托咪定复合丙泊酚在老年患者内镜胰胆管造影术中的应用[J].临床麻醉学杂志, 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. 詹银周, 张兴安, 邵伟栋, 等.右美托咪定在臂丛神经阻滞麻醉中的应用[J].中国新药与临床杂志, 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. 黄青青.右美托咪啶在重症监护病房中的应用[J].中国危重病急救医学, 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. 刘小南, 俞德梁, 赵青川, 等.关于日间手术模式的研究及应用进展[J].医学与哲学, 2014, 35(4):56-59.
19. 赵素真.门诊手术麻醉进展[J].临床麻醉学杂志, 2003, 19(2):127-128.
20. 黄长炉, 江鹤群, 陈国忠, 等.小剂量右美托咪定持续泵注辅助颈丛阻滞的临床观察[J].临床麻醉学杂志, 2011, 27(8):803-804.
21. 杨自娟, 张兴安, 胡渤, 等.右美托咪定用于下肢手术镇静的适宜负荷剂量探讨[J].中国药房, 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. 张磊, 李倩, 葛亚丽, 等.右美托咪定复合丙泊酚在老年患者内镜胰胆管造影术中的应用[J].临床麻醉学杂志, 2013, 29(4):377-378.

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右美托咪定的作用机制及其在门诊麻醉中的应用

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