右美托咪啶对鼻内镜手术控制性降压术后血压的影响

The effect of dexmedetomidine on post-operative blood pressure after controlled hypotension in endoscopic sinus surgery

目的:观察围术期应用右美托咪啶对鼻内镜手术控制性降压术后血压的变化。方法:择期鼻内镜手术患者60例,分右美托咪啶实验组(D组)和生理盐水对照组(S组),同样方案麻醉诱导后D组静脉注射右美托咪啶,负荷剂量0.8μg/kg(10 min泵注完),然后以0.5μg/(kg.h)维持静脉注射30 min,S组以同样方式输注生理盐水。记录术后拔管前1 min(T1)、拔管时(T2)、拔管后10 min(T3)、拔管后30 min(T4)、拔管后2 h(T5)、拔管后4 h(T6)各时点的平均动脉压(MAP)及HR,观察术后患者发生不良反应情况和患者鼻腔填塞物及口腔渗出液的量及颜色。结果:S组术毕拔管时及拔管后各时点MAP和HR均较术后拔管前1 min明显升高(P<0.05),D组各时点MAP和HR的变化不明显(P>0.05),S组术后各时点的MAP和HR较D组升高(P<0.05)。术后鼻腔有渗出的例数S组明显多于D组(27∶18)(P<0.05),且渗出量也较多。结论:围术期应用右美托咪啶能明显减少鼻内镜手术控制性降压术后血压的波动,能稳定术后血流动力学,减少鼻腔出血。

Objective：To observe the variance of blood pressure（BP） after controlled hypotension in endoscopic sinus surgery with dexmedetomidine.Method：Sixty patients undergoing elective endoscopic sinus surgery were randomly assigned to receive dexmedetomidine（Group D） or physiological saline（Group S）.For the two groups,after the same induction of anesthesia procedure,Group D were injected with dexmedetomidine with 0.8 μg/kg of priming dose in 10 min and 0.5 μg/（kg·h）of maintenance dose i.v.drip for 30 min.The Group S were injected with physiological saline in the dose the same as Group D.The measurement of the mean aortic pressure（MAP）,heart rate（HR） and the colouration of the Nasal packing material and exudation were taken at the end of the surgery（T1）,at the time of extubation（T2）,10 min after extubation（T3）,30 min after extubation（T4）,2 h after extubation（T5）,and 4 h after extubation（T6）.Result：The MAP and HR of Group S at the points T2-T6 were significantly higher compared with those at the point T1（P〈0.05）.The MAP and HR of Group D at each time point did not change significantly（P〉0.05）.The MAP and HR of Group S at each time point were higher compared with Group D（P〈0.05）.The number of cases with postoperative nasal exudate in Group S was significantly more than in Group D（27∶18）（P〈0.05）.Conclusion：The perioperative dexmedetomidine medication can significantly reduce fluctuations in BP in endoscopic sinus surgery,so that to stable hemodynamics and reduce nasal bleeding.