右美托咪定联合复方利多卡因乳膏对口腔颌面部肿瘤术后气管切开的镇静和镇痛效果

Study of the sedative and analgesic effect of combining dexmedetomidine with lidocaine cream during recovery period after tracheotomy in oral and maxillofacial tumor surgery

目的探讨右美托咪定联合复方利多卡因乳膏对口腔颌面部肿瘤手术患者术后气管切开的镇静和镇痛效果。方法将口腔颌面部肿瘤术后需要气管切开的60例患者随机分为右美托咪定联合利多卡因乳膏组(R组,20例)、右美托咪定组(D组,20例)、0.9%氯化钠溶液组(N组,20例)。在开始缝合切口时(约术毕前1 h),R组和D组分别用30 min输注右美托咪定0.5μg/kg,N组以同样的时间输注同等剂量的0.9%氯化钠溶液。在术毕气管切开更换气管套管时,R组在气管套管外壁涂抹利多卡因乳膏。比较三组患者的苏醒时间、苏醒期间呛咳、躁动的情况以及心率(HR)、血压(BP)和呼吸(RR)的变化。采用SPSS 17.0软件包对数据进行统计学处理。结果 (1)三组苏醒时间差异无统计学意义(P=0.266);(2)苏醒期R组追加芬太尼的次数和追加芬太尼后血氧饱和度(Sp O2)下降至90%以下的例数均明显少于D组和N组(D组:χ2=7.619,P=0.006,χ2=8.547,P=0.003;N组:χ2=25.600,P<0.05,χ2=24.000,P<0.05),D组少于N组(χ2=7.619,P=0.006;χ2=6.995,P=0.008);(2)苏醒时呛咳评分R组明显低于D组和N组(D组:P=0.006;N组:P<0.05),D组明显低于N组(P=0.007),追加芬太尼后D组和N组呛咳评分明显下降,苏醒30 min至1 h又再度上升,而R组的呛咳评分在苏醒期各时间点都较低且无明显波动(F=0.716,P=0.702);(3)苏醒期Rass评分显示R组一直处于平稳的最佳镇静状态(F=0.886,P=0.662),而D组和N组的镇静程度不佳,在追加芬太尼前后呈现由烦躁到镇静过度的转变,其中N组最为明显(D组:F=4.335,P=0.017;N组:F=20.476,P<0.05);(4)麻醉诱导前与苏醒期R组HR、BP及RR的变化均不明显(HR:F=1.876,P=0.225;MAP:F=1.520,P=0.301;RR:F=1.112,P=0.465),D组和N组的波动比较明显,其中N组波动最明显(D组HR:F=3.472,P=0.041;MAP:F=3.465,P=0.042;RR:F=3.982,P=0.032;N组HR:F=5.674,P=0.005;MAP:F=5.442,P=0.006;RR:F=15.232,P<0.05)。结论右美托咪定静脉注射联合利多卡因乳膏涂抹气管套管用于术毕气管切开的患者,能明显减少全麻苏醒期患者的呛咳和躁动,使苏醒期血流动力学平稳,且不延长苏醒时间。

Objective To explore the sedative and analgesic effect of combining dexmedetomidine with lidocaine cream during recovery period after tracheotomy in oral and maxillofacial tumor surgery. Methods Sixty patients who needed to get tracheotomy after oral and maxillofacia l tumor surgery were randomly divided into three groups. When suturing incision, dexmedetomidine at 0.5 μg/kg in Group R and D, and saline in Group N were administrated intravenously for 30 minutes . When replacing the tracheal tube in tracheotomy, Group R was smeared by lidocaine cream on the surface of the tracheal tube. Coughing, dysphoria, recovery time, MAP, HR and RR were recorded. SPSS 17.0 software package were used for data processing. Results There was no significant difference in recovery time among the three groups （P=0.266）. Times of adding fentanyl and cases of SpO2 declining below 90%after adding fentanyl in Group R were obviously fewer than those in Group D and Group N （Group D：χ2=7.619,P=0.006,χ2=8.547,P=0.003;Group N：χ2=25.600,P〈0.05,χ2=24.000,P〈0.05）, while those in Group D were also obviously fewer than those in Group N （χ2=7.619,P=0.006;χ2=6.995,P= 0.008）. During recovery time, there were no significant changes of Rass score, coughing score, HR, MAP or RR in Group R （P〉0.05）, while those in Group D and Group N changed a lot along with adding fentanyl （P〈0.05）, especially in Group N （P〈0.05）. Conclusion Dexmedetomidine combining with lidocaine cream is effective in attenuating coughing , dysphoria and hemodynamic changes during recover period for patients undergoing tracheotomy after oral and maxillofacial tumor surgery . Besides, it do not extend the recovery period.