盐酸右美托咪定在鼻内镜手术局麻中的辅助作用

Auxiliary application of dexmedetomidine hydrochloride in patients undergoing endoscopic nasal surgery under local anesthesia

目的:研究盐酸右美托咪定在局麻鼻内镜手术的辅助作用。方法:60例择期鼻内镜手术患者,美国麻醉医师协会Ⅰ、Ⅱ级,随机分为右美托咪定组(D组,n=30)和对照组(C组,n=30),D组患者术前先经输液泵缓慢静脉注射右美托咪定0.5μg/kg负荷剂量,10 min泵完,然后以0.5μg/(kg·h)速率持续泵注至术毕。C组持续泵注相同容量的生理盐水至术毕。2组患者均在局麻下完成鼻内窥镜手术。记录2组患者麻醉前(T0)、手术开始(T1)、手术30 min(T2)及术毕(T3)平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(saturation of pulse oxygen,SPO2)、呼吸频率(respiratory rate,RR)、镇痛镇静评分及不良反应。结果:在T1、T2、T3时点,D组HR、MAP、RR、疼痛视觉模拟评分均低于C组,而镇静Ramsay评分高于C组,具有统计学差异(P<0.01),各个时点D组与C组SPO2均未见统计学差异(P>0.05)。与C组相比,D组患者麻醉手术中恶心、呕吐、呼吸抑制等不良反应发生率未见统计学差异(P>0.05)。结论:静脉应用小剂量右美托咪定可以减轻局麻鼻内镜手术患者术中疼痛,有效减少血流动力学波动,并提供一定的镇静效果,且对呼吸不产生抑制,值得临床推广应用。

Objective：To investigate the auxiliary application of dexmedetomidine hydrochloride in patients undergoing endoscopic nasal surgery under local anesthesia. Methods： A total of 60 patients of American Society of Anesthesiology I , undergoing elective endoscopic nasal surgery were randomly divided into two groups （30 cases in each group） ：dexmedetomidine group （group D） and control group（group C）. 0.5 μg/kg dexmedetomidine was infused slowly for 10 min in patients of group D by intravenous pump before operation, and then it was infused continuously until the end of the operation at velocity of 0.5 μg/（kg＇h）. The same volume of saline was infused continuously until the end of the operation in control group. Endoscopic nasal surgery was completed under local anesthesia in both groups. Patients＇ mean arterial pressure（MAP）, heart rate（HR）, saturation of pulse oxygen（SPO2）, respiratory rate （RR）, score of sedation or analgesia and adverse reactions were recorded in two groups at the following time points：before anesthesia （To）, operation beginning （T1）, 30 min during operation （T2）, end of the operation （T3）. Results： HR, MAP, RR, visual analogue scale score, in group D were significantly lower than those in group C at T1 ,T2, Ta（P〈0.01） but Ramsay score in group D was significantly higher than that in group C at ,T2,Ta（P〈0.01）. There was no difference in SPO2 at every time point in the two groups（P〉0.05）. There was no significant difference in incidences of nausea, vomiting, respiratory inhibition in D group （P 〉0.05）. Conclusions ： Intravenous administration of low dose of dexmedetomidine could relieve pain in patients undergoing endoscopic nasal surgery under local anesthesia,reduce fluctuation of hemodynamic and exert certain sedative effects without inhibiting respiratory inhibition,there-fore it is worthy of clinical application.