右美托咪定与艾司洛尔对鼻内镜手术患者控制性降压的对比研究

The comparative study of dexmedetomidine verus esmolol inducing controlled hypotension in patients of endoscopic sinus surgery

目的比较右美托咪定与艾司洛尔在鼻内镜手术患者控制性降压中的应用效果。方法选择择期全麻下行鼻内镜手术患者60例,随机均分为两组,采用右美托咪定（D组）、艾司洛尔（E组）行控制性降压。桡动脉穿刺置管监测有创动脉压,维持平均动脉压（MAP）在55~65 mmHg。记录入室麻醉前（t0）、麻醉后5 min（t1）、术中30 min（t2）、术中60 min（t3）、停止降压后5 min（t4）、恢复室拔管后5 min（t5）6个时点的HR、MAP。记录降压达标时间、降压持续时间、丙泊酚诱导用量、芬太尼用量、出血量、手术时间、拔管时间,对术野质量和苏醒期清醒镇静程度进行评定,观察有无副作用,并于术前、降压后45 min和手术结束即刻抽桡动脉血行血气分析。结果在手术时间、降压达标时间、降压持续时间、出血量、术野质量、血气分析中,两组比较差异无统计学意义（P〉0.05）,两组患者术中MAP均能维持在目标范围。与E组比较,D组HR、MAP在t0、t1、t2、t3的差异无统计学意义,t4、t5时点降低（P〈0.05）。与E组比较,D组患者丙泊酚诱导用量、芬太尼用量减少（P〈0.05）,拔管时间、疼痛耐受时间延长（P〈0.05）,苏醒期清醒镇静程度评分更高（P〈0.05）。结论右美托咪定和艾司洛尔均可安全用于鼻内镜手术患者控制性降压,但右美托咪定在镇痛、镇静和节省麻醉药方面更有优势。

【Objective】The comparison application of dexmedetomidine verus esmolol inducing controlled hypotension inducing controlled hypotension in patients of endoscopic sinus surgery.【Methods】Sixty patients subjected general anesthesia were randomLy divided into two groups, all 30 cases：the dexmedetomidine（group D）, the esmolol group（E group）. Radial artery cannulation monitoring invasive mean arterial pressure（MAP）, maintenance of MAP in 55-65mmHg. HR、 MAP were recorded before treatment（t0）, 5min after anesthesia（t1）, 30min operation（t2）, 60min operation（t3）, stop 5min after hypotension（t4）, 5min after extubation（t5）. The time from the begining of opration to the target hypotension,duraion of operation and hypotension,extubation time,amotmt of bleeding,propofol and fentanyl dosage. Quality of the surgical field,the consciousness of patients and compblication were assessed and preoperative blood pressure, 45 min and operation at the end of the radial artery for blood gasses.【Results】There were no significant difference in the time from the begining of opration to the target hypotension,duration of operation and hypotension, amount of bleeding volume, quality of the surgical field（P〉0.05）. No significant changes were observed in arterial blood gases, the MAP can maintain in the target range in the two groups.There were no significant difference in MAP,HR in the two groups at the t0、t1、t2、t3. Compared with group E,There was significant decreased in MAP、HR at the t4 and t5 in group E.The pain tolerance time was shorter in group E than group D.The extubation time was longer in group D than group E.There was no signiificant difference in blood gases between the two gmups.No significant changes were observed in arterial blood gases. The sedation score were significantly lower in E group compared with D group at 30 and 45 minutes postoperatively. Mean intraoperative fentanyl and propofol consumption was significantly lower in D group than E group（P〈0.05）.【Conclusion】Both dexmedetomidine or esmolol are safe agents for controlled hypotension in providing ideal surgical field during endoscopic sinus surgery.Compared with esmolol,dexmedetomidine offers the advantages in analgesia, sedation and anesthetic sparing effect.