右美托咪定联合氟比洛芬酯辅助全麻对难治性鼻窦炎鼻内镜手术的影响

Effect of depressurization and general anesthesia assisted with dexmedetomidine and flurbiprofen in treating the difficult-to-treat rhinosinusitis with endoscopy

目的研究右美托咪定联合氟比洛芬酯辅助全麻对难治性鼻窦炎患者鼻内镜手术的临床效果。方法选取我院2015年1月至2016年6月耳鼻喉科难治性鼻窦炎患者68例,按照随机数字生成器分为观察组与对照组,每组34例。对照组采用常规全麻鼻内镜手术治疗;观察组在对照组的基础上,术前与术后加用氟比洛芬酯抗炎止痛,术中给予右美托咪定辅助治疗,观察两组患者术中、术后7 d的临床表现,采用视觉模拟评分(VAS)、Lund-Mackay鼻窦CT评分对主要症状改善进行评价。比较两组患者麻醉达标时间、术后拔管时间与术中出血量,采用手术术野评分表(SSFQ)评价术野质量,采用Ramsay镇静评分表评价复苏质量。观察术后麻醉并发症情况。结果对照组患者的总有效率为82.35%,观察组为91.18%,两组比较差异无统计学意义(P>0.05),但对照组患者的痊愈率仅为14.71%,而观察组为41.77%,差异具有统计学意义(P<0.05);观察组患者麻醉达标所需时间为(15.26±2.47)min,少于对照组的(17.39±3.10)min,术后拔管时间为(12.09±2.3)min,也明显少于对照组的(17.74±2.61)min,而对照组患者的出血量为(149.53±21.26)m L,明显多于观察组的(122.43±18.79)m L,差异均有统计学意义(P<0.05);观察组患者的SSFQ评分为(1.76±0.47)分,低于对照组的(2.69±0.31)分,差异有统计学意义(P<0.05);此外,观察组患者的Ramsay评分为(2.03±0.58)分,也低于对照组的(3.47±0.45)分,差异有统计学意义(P<0.05);术后7d,观察组患者的VAS评分为(1.92±1.09)分,明显低于对照组的(3.16±2.45)分,差异有统计学意义(P<0.05)。结论右美托咪定能够辅助控制性降压在DTR全麻鼻内镜手术中的应用,还可以通过减少呼吸抑制与通过调节自然非动眼睡眠状态而提高术后的苏醒恢复,氟比洛芬酯术前应用具有抗炎效果,两者联合辅助治疗不仅能够减少出血量以提高手术术野质量,还可以通过减少机体炎症反应而提高术后的恢复情况,近期疗效痊愈率优于常规围手术方案。

Objective To investigate the effect of depressurization and general anesthesia assisted with dexmedetomidine and flurbiprofen in treating the difficult-to-treat rhinosinusitis（DTR） with endoscopy. Methods A total of68 patients with DTR in Department of ENT in Yunfu People＇s Hospital from January 2015 to June 2016 were selected.They were divided into observation group and control group by the random number generator, with 34 patients in each group. Patients in the control group were treated with the conventional endoscopy operation with the depressurization and general anesthesia, while the observation group was given dexmedetomidine and flurbiprofen on the basis of control group as the assistant medication during the perioperative period. The manifestations after the surgery and 7 d were observed, and visual analogue scale（VAS） and the paranasal sinus CT Lund-Mackay scale were used to evaluate the main symptom improvement. Moreover, the time to reach anesthetic effect, extubation time after the operation, and the intraoperative blood loss during the surgery were compared between the two groups. Then the scores of surgical field quality（SSFQ） was used to evaluate the quality of the surgical field, while the Ramsay sedation scale was used to evaluate the quality of recovery. Results The total effective rate of control group was 82.35%, and that of the observation group was 91.18%, with no statistically significant difference between the two groups（P〈0.05）. However, the cure rate of control group was only 14.71%, which was significantly lower than 41.77% in the observation group, P〈0.05. The time to reach anesthetic effect in the observation group（15.26±2.47） min was significantly less than（17.39±3.10） min in the control group（P〈0.05）. The extubation time after the operation in the observation group（12.09±2.33） min was significantly less than（17.74 ± 2.61） min in the control group（P〈0.05）. Nevertheless, the blood loss in the control group（149.53 ±21.26） m L was significantly more than（122.43±18.79） m L in the observation group（P〈0.05）. The SSFQ score in the observation group was（1.76±0.47）, which was significantly lower than（2.69±0.31） in the control group, P〈0.05. In addition, the Ramsay scale in observation group was（2.03±0.58）, which was significantly lower than（3.47±0.45） in the control group, P〈0.05. At 7-day after the operation, the VAS score in the observation group was significantly less than that in the control group,（1.92 ± 1.09） vs（3.16 ± 2.45）, P〈0.05. Conclusion Dexmedetomidine combined with flurbiprofen can assist the depressurization and general anesthesia in treating DTR with the endoscopy. It could not only decrease the blood loss for improving the surgical field, but also it could regulate the inflammatory reaction to help the patients promote the body recovery, and the cure rate of short-term effect was better than the conventional operation.