右美托咪定与咪达唑仑在术中神经监测下全甲状腺切除术中的比较：一项前瞻性非随机研究
Dexmedetomidine versus midazolam during total thyroidectomy with intraoperative neuromonitoring: A prospective non-randomized study.
文献信息
| PMID | 42762500 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Suat Evirgen |
| 作者单位 | Department of General Surgery, Faculty of Medicine, Amasya University, Amasya, Türkiye. |
| 期刊 | Biomolecules & biomedicine |
| SCI 分区 | Q3 |
| IF | 2.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
麻醉辅助药物可能影响甲状腺切除术中的术中神经监测（IONM）。我们比较了右美托咪定和咪达唑仑作为丙泊酚全静脉麻醉（TIVA）辅助药物的效果。这项前瞻性、单中心、非随机、非盲研究纳入60例接受择期全甲状腺切除术并间歇性IONM的成人，交替分配至右美托咪定或咪达唑仑组（每组30例）。主要结局为第一解剖侧从皮肤切开至喉返神经（RLN）识别的时间；次要结局为探索性。右美托咪定组RLN识别时间的中位数（四分位距）更短（21.0 [19.0-26.8] 分钟 vs 27.0 [21.2-31.0] 分钟；Hodges-Lehmann中位数差，-4.0分钟；95%置信区间[CI]，-7.0至-1.0；p < 0.001）。迷走神经识别时间的中位数也更短（12.5 vs 17.0分钟；p < 0.001），而总手术时间无差异。右美托咪定组切除前肌电图（EMG）振幅在迷走神经（810 vs 905 µV）和RLN（835 vs 1000 µV；均p < 0.001）较低，但所有记录的振幅均≥700 µV，无信号丢失。中位拔管和恢复时间更短（分别为8.0 vs 13.0分钟和6.0 vs 9.0分钟；均p < 0.001）。心动过缓发生率分别为16.7% vs 0%（p = 0.052）。右美托咪定与更短的神经识别时间和早期恢复时间相关，尽管较低的EMG振幅和观察到的心动过缓需要谨慎。这些发现需要随机对照确认；未评估术后声带功能，因此无法就神经安全性得出结论。
英文摘要
Anesthetic adjuncts may influence intraoperative neuromonitoring (IONM) during thyroidectomy. We compared dexmedetomidine and midazolam as adjuncts to propofol-based total intravenous anesthesia (TIVA). This prospective, single-center, non-randomized, unblinded study included 60 adults undergoing elective total thyroidectomy with intermittent IONM, assigned alternately to dexmedetomidine or midazolam (30 per group). The primary outcome was recurrent laryngeal nerve (RLN) identification time from skin incision on the first dissected side; secondary outcomes were exploratory. Median (interquartile range) RLN identification time was shorter with dexmedetomidine (21.0 [19.0-26.8] versus 27.0 [21.2-31.0] minutes; Hodges-Lehmann median difference, -4.0 minutes; 95% confidence interval [CI], -7.0 to -1.0; p < 0.001). Median vagus nerve identification time was also shorter (12.5 versus 17.0 minutes; p < 0.001), whereas total operative time did not differ. Pre-resection electromyography (EMG) amplitudes were lower with dexmedetomidine at the vagus nerve (810 versus 905 µV) and RLN (835 versus 1000 µV; both p < 0.001), but all recorded amplitudes were ≥700 µV, with no loss of signal. Median extubation and recovery times were shorter (8.0 versus 13.0 and 6.0 versus 9.0 minutes, respectively; both p < 0.001). Bradycardia occurred in 16.7% versus 0% of patients (p = 0.052). Dexmedetomidine was associated with shorter nerve identification and early recovery times, although lower EMG amplitudes and observed bradycardia warrant caution. These findings require randomized confirmation; postoperative vocal cord function was not assessed, precluding conclusions about nerve safety.