右美托咪定在复合麻醉下鼻内镜手术中控制性降压的效果

The clinical effect of dexmedetomidine on controlled hypotension in endoscopic sinus surgery under combined anesthesia

目的 探讨右美托咪定在复合全麻下鼻内镜手术中控制性降压的安全性、有效性.方法 择期行全麻下鼻内镜手术的患者80例,按照计算机生成的随机序列分为两组：右美托咪定组（D组）和硝酸甘油组（N组）,分别使用上述两种药物进行术中控制性降压.术中维持患者的平均动脉压（MAP）于60~70 mmHg（1 mmHg=0.133 kPa）.评价手术开始后5 min（T1）、15 min（T2）、45 min（T3）时刻的术野质量,记录T1、T2、T3时刻以及苏醒期拔管即刻（T4）患者的心率（HR）、平均动脉压（MAP）、术中总出血量、尿量.结果 与N组相比,D组患者的术野质量评分升高（P＜0.05）;T1、T2、T3时刻HR降低（P＜0.05）,T4时刻D组患者的血压、心率波动较小（P＜0.05）.D组患者出血量较少（P＜0.05）,尿量较多（P＜0.05）.结论 右美托咪定可安全用于静脉与吸入复合全麻下鼻内镜手术的术中控制性降压.

Objective To investigate the safety and effectiveness of dexmedetomidine on controlled hypotension in endo- scopic sinus surgery combined anesthesia. Methods Eighty patients undergone endoscopic sinus surgery was divided into two groups according to the random sequence generated by the computer： dexmedetomidine group （D group） and nitroglycerin group （N group）, these two drugs were used to control hypotension in operation. The mean arterial pressure （MAP） was main- tained at 60~70 mmHg （1 mmHg=0.133 kPa） in patients with anesthesia in surgery. Surgery field quality of 5 min （T1）, 15 rain （T2）, 45 min （T3） after operation was evaluated, indicators of T1, T2, T3 and imnediate extubation at recovery period （T4） in patients were recorded, such as heart rate （HR）, mean arterial pressure （MAP）, the total amount of bleeding, urine volume. Results Compared with N group, the surgical field quality score of D group increased （P〈0.05）; HR of T1, T2, T3 reduced （P〈0.05）, The blood pressure, heart rate of D group fluctuated less （P〈0.05）. D group had less bleeding and more, urine amount （P〈0.05）. Conclusion Dexmedetomidine can be safely used to control hypotension in endoscopic sinus surgery under combined intravenous and inhalation anesthesia.