右美托咪定对功能性鼻内窥镜手术患者苏醒期质量的影响

Effects of Dexmedetomidine Infusion on the Recovery Profiles.in Patients Undergoing Functional Endoscope Sinus Surgery

【目的】研究术中输注右美托咪定对功能性鼻内窥镜手术（FESS）患者苏醒期质量的影响。【方法】选取40例年龄为30～60岁择期全身麻醉下行FESS的患者。将入选患者随机分为两组（每组20例）：对照组（C组）和右美托咪定组（D组）。常规麻醉诱导气管插管后，D组给予1μg／kg右美托咪定10min内静脉输注完毕，随后以0．2ug／（kg·h）速率输注至手术结束前30min。C组以同样方式输注等量生理盐水。两组麻醉维持均采用静脉持续输注异丙酚，七氟醚吸入，适时静注顺式阿曲库铵。当患者平均动脉压（MAP）和心率（HR）较基础值增加超过15％时单次追加芬太尼1.5μg／kg。比较两组患者麻醉前、手术结束时、拔管时、离开麻醉恢复室（PACU）时的HR、MAP；入PACU后的Riker躁动评分、VAS疼痛视觉模拟评分；拔管时间、滞留PACU时间以及术后不良反应情况。【结果】与麻醉前比较，C组患者拔管时HR明显增快（P〈0．05）。入PACU后D组Riker躁动评分和VAS疼痛视觉模拟评分均低于C组（P〈0．05）。两组拔管时间、滞留PACU时间的差异均无显著性（均P〉0．05）。D组术后寒战发生率低于C组（P〈0．05）。【结论】术中输注右美托咪定可明显改善FESS患者苏醒期质量。

[Objective] To investigate the effects of continuous infusion of dexmedetomidine on postoperative recovery after functional endoscope sinus surgery（FESS）. [Methods] Forty patients aged 30 to 60 years who were scheduled for FESS under general anesthesia were included in this study. Participants were randomly assigned to 2 groups （ n = 20 each） ： control group, group C; dexmedetomidine group, group D. Ten minutes after the induction of anesthesia dexmedetomidine in a dose of 1μg/kg over 10 min, a continuous infusion of 0.2 μg/（kg · h） until 30 min before the end of surgery was conducted in group D. Group C received normal saline instead. Anesthesia was maintained with propofol and sevoflurane. Additional cisatracurium was added if necessary. Fentanyl 1.5 μg/kg was given to subjects in both groups for an increase in HR or MAP 15% above pre-incision values. HR and MAP were recorded at the following time points： arriving at OR （operation room）, the end .of surgery, at tracheal extubation, and when discharging from PACU. Riker scores and VAS were assessed 10, 20, 30min after entrance into PACU. Time to extubation, discharge from PACU, and post- operative adverse events such as vomiting or shivering were also recorded. [ResultsI Compared with baseline HR, HR increased by the time of tracheal extubation in group C. Riker scores and VAS were lower in group D （ P 〈0.05）. Times from extubation to discharge in PACU were similar between the two groups （ P 〉0.05）. The incidence of shivering was decreased in group D （ P 〈0.05）. [Conclusion ] Intraoperative administration of dexmedetomidine seems to promote postoperative recovery in patients undergoing FESS.