鼻内镜手术患者右美托咪定鼻腔给药辅助局部麻醉的效果

Efficacy of dexmedetomidine administered intranasally used to supplement local anesthesia for nasal endoscopic surgery

目的评价鼻内镜手术患者右美托咪定鼻腔给药辅助局部麻醉的效果。方法择期局部麻醉下行鼻内镜手术患者60例，性别不限，年龄18～60岁，BMI〈35kg／m^2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将其分为2组（n=30）：右美托咪定鼻腔给药联合局部麻醉组（DL组）和局部麻醉组（L组），DL组局部麻醉前60min双侧鼻孔依次滴注右美托咪定0．5μg／kg。分别于鼻腔给药前（基础状态）、鼻腔给药后5、30min时、局部麻醉前即刻、手术开始、手术开始后30rain、术毕和术后30min时记录SP、DP和HR，并计算心率-收缩压乘积（RPP）。分别于术前和术毕时采集静脉血样，测定血浆肾上腺素、去甲肾上腺素、IL-6、IL-8、TNF-α的浓度和血糖。记录右美托咪定有关呼吸抑制、低血压和心动过缓的发生情况，记录术中体动次数、出血量、术野质量及术者和患者对麻醉的满意度评分；记录患者对止血填塞物的耐受程度和术后需要镇痛情况。结果与L组比较，DL组SP、DP、HR和RPP降低，术毕时血浆肾上腺素、去甲。肾上腺素、IL-6、TNF—α的浓度和血糖降低，体动次数、出血量和术后需要镇痛率降低，术野质量、对止血填塞物耐受程度、术者及患者对麻醉的满意度评分升高（P〈0．05或0．01）。未见右美托咪定有关不良事件发生。结论右美托咪定鼻腔给药辅助局部麻醉用于鼻内镜手术患者时可提供良好的镇痛效果，有助于维持血流动力学平稳，可降低应激和炎性反应，且有利于手术操作。

Objective To evaluate the efficacy of dexmedetomldine administered intranasally used to supplement local anesthesia for nasal endoscopic surgery. Methods Sixty patients of both sexes, aged 18-60 yr, with body mass index 〈35 kg/m^2 , of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective nasal endoscopic surgery under local anesthesia, were equally and randomly allocated into either dexmedetomidine administered intranasally combined with local anesthesia group （group DL） or local anesthesia group （group L）. Dexmedetomidine 0.5 μg/kg was instilled into the bilateral nostrils at 60 rain before local anesthesia in group DL. Before intranasai administration （baseline）, at 5 and 30 rain after intranasal administration, immediately before local anesthesia, at the beginning of surgery, at 30 min after beginning of surgery, at the end of surgery, and at 30 rain after surgery, systolic blood pressure （SP）, diastolic blood pressure （DP）, and heart rate （HR） were recorded, and rate-pressure product （RPP） was calculated. Venous blood samples were collected before surgery and at the end of surgery for determination of plasma epinephrine, norepinephrine, interleukin-6 （IL-6）, IL-8, and tumor necrosis factor-alpha （TNF-cx） concentrations and blood glucose. The occurrence of dexmedetomidine-related respiratory depression, hypotension and bradycardia was recorded, the number of body movement, blood loss, and surgical field quality were recorded, and the surgeon＇s and patient＇s satisfaction with anesthesia was scored. Patient＇s tolerance to hemostatic stuffing was assessed, and the requirement for analgesia was recorded. Results Compared with group L, SP, DP, HR and RPP were significantly decreased, the plasma epinephrine, norepinephrine, IL-6, IL-8, and TNF-α concentrations and blood glucose were significantly decreased, the number of body movement, blood loss, and requirement for analgesia were significantly decreased, and the surgical field quality, degree of patient＇ s tolerance to hemostatic stuffing, and score for surgeon＇s and patient＇s satisfaction with anesthesia were significantly increased in group DL （P〈0.05 or 0.01）. No dexmedetomidine-related adverse events were observed. Conclusion Dexmedetomidine administered intranasally used to supplement local anesthesia can provide good analgesic efficacy, is helpful in maintaining stable hemodynamics, can decrease stress and inflammatory responses, and is helpful for the operative procedure when used for nasal endoscopic surgery.