不同剂量右美托咪定抑制FESS术后拔管期不良反应的效果观察

Observation of Inhibitory Effect of Different Doses of Dexmedetomidine on ADR during Extubation after Functional Endoscopic Sinus Surgery

目的：研究右关托咪定抑制功能性鼻内镜窦手术（FESS）术后拔管期不良反应的有效性和剂量。方法：将择期行FESS患者80例，随机分为A、B、C、D组，每组20例，所有患者均采用丙泊酚与瑞芬太尼靶控输注气管插管全麻，B、C、D组患者手术结束前15min分别静脉输注右美托咪定0．3、0．6、O．9gg／kg，A组静脉输注等剂量生理盐水。记录手术时间、拔管时间、麻醉前（T0）、拔管即刻（T1）、拔管后5min（T2）、10min（T3）的平均动脉压（MAP）和心率（HR），观察拔管期呛咳反应、视觉模拟评分（vAs）、Ramsay镇静评分、躁动评分及喉痉挛、低氧血症的发生率。结果：D组患者拔管时间长于其他组（P〈O．05）；A组患者T1～T3时点MAP、HR高于To时点（P〈0．05）；B、C、D组患者Tz、T3时点MAP、HR低于A组（P〈0．05）；C、D组患者T1时点MAP、HR低于A、B组（P〈0．05）；C、D组患者呛咳反应和VAS优于A、B组（P〈O．05）；D组患者Ramsay镇静评分高于其他组（P〈0．05）；A组患者躁动评分高于其他组（P〈O．05）。结论：O．6μg／kg右关托咪定用于FESS术后拔管，可减轻拔管期的呛咳反应和躁动，提高镇痛质量，保持血流动力学平稳，而不增加麻醉深度。

OBJECTIVE： To investigate the effectiveness and dose of dexmedetomidine on suppressing ADR during extubation after functional endoscopic sinus surgery （FESS）. METHODS： 80 patients underwent selective FESS were randomly divided into group A, B, C and D with 20 cases in each group. All patients were given general anesthesia with target-controlled infusion of pro- pofol and remifentanil. Group B, C, D received intravenous injection of 0.3, 0.6, 0.9 μg/kg dexmedetomidine 15 minutes before the end of surgery, respectively; group A received the same dose of normal saline intravenously. The operation time and extubation time were recorded. MAP and HR were determined before anesthesia （T0）, immediately after extubation （T1）, at 5 min after extu- bation （T2）, at 10 min after extubation （T3）. The cough, VAS, Ramsay sedation scale, agitation grade, the incident of laryngo- spasm and hyoxemia were also observed during extubation. RESULTS： The extubation time was longer in group D than in other groups（P〈0.05）. MAP and HR of group A at T1-T3 were higher than at To （P〈0.05）. MAP and HR of group B, C and D were lower than those of group A at T2-T2 （P〈0.05）. At T1, MAP and HR were lower in group C and D than group A and B （P〈0.05）. The cough and VAS were better in group C and D than in group A and B（P〈0.05）. Ramsay scale was higher in group D and agita- tion grade was higher in group A（P〈0.05）. CONCLUSIONS： Dexmedetomidine 0.6 μg/kg for extubation after FESS can attenuate cough and agitation, improve analgesia quality, maintain stable hemodynamics, but not enhance anesthetic depth.