右美托咪定与丙泊酚复合麻醉用于鼻内镜经蝶垂体瘤切除术的效果

Effect of Dexmedetomidine Combined with Propofol on the Endoscopic Transsphenoidal Pituitary Adenoma Surgery

目的:研究右美托咪定(Dexmedetomidine)与丙泊酚复合麻醉应用于鼻内镜经蝶窦垂体瘤切除手术的临床效果。方法:选择2015年3月至2015年12月首都医科大学宣武医院神经外科内镜下收治的经鼻蝶垂体瘤切除术患者70例,随机分为右美托咪定组(T组)和对照组(C组)。T组在诱导前15分钟泵入右美托咪定,对照组则泵入等量盐水,两组均给予丙泊酚进行麻醉诱导。观察和比较两组患者入室后15 min(T_0)、插管前(T_1)、插管后5 min(T_2)、插管后10 min(T_3)、拔管后5 min(T_4)、拔管后10 min(T_5)心率、收/舒张压变化,术中15 min(T_6)及30 min(T_7)Fromme术野质量评分和拔管时(T_8)及拔管后1 hour(T_9)Ramsay镇静评分。结果:T组插管后5 min(T_2)、拔管后5 min(T_4)和拔管后10 min(T_5)收缩压、舒张压及心率均显著低于对照组(C组)对应时间点收缩压(P<0.05)。两组插管前心率(HR)均低于入室时15 min分钟心率(P<0.05)。T组T7时间点术野质量评分高于C组(P<0.05),拔管后2小时两组Ramsay镇静评分无统计学意义。两组术后苏醒时间及拔管时间比较差异均无统计学意义(P>0.05)。结论:右美托咪定联合丙泊酚用于内镜经蝶窦垂体瘤切除术有利于稳定患者心率、收/舒张压,显著改善术野质量评分。

Objective： To study the clinical effects of dexmedetomidine combined with propofol on the endoscopic pituitary surgery. Methods： Seventy cases of patients from the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University were randomly divided into two groups （n=35）. The group T was intravenously pumped by dexmedetomidine at 15 min before induction, the Group C was intravenously pumped by saline. The same anesthetic induction method was used propofol in both groups. The systolic, di- astolic blood pressure and heart rate of two groups were observed at different time points, the extubation time, the intraoperative Fromme operative field quality score and Ramsay sedation scores at extubation of two groups were observed. Results： Compared with the group C, the systolic and diastolic blood pressure, as well as heart rate at 5 mins after intubation, 5 mins after extubation and 10 mins after extubation were significantly lower than those of the control group at the same time points （P〈0.05）. The heart rate before intubation were obviously lower than those at 15 mins after entrancing （P〈0.05）. The scores of Fromme Operative field quality at T7 time point in group T were higher than that of the group C （P〈0.05）. No significant difference was found in the Ramsay sedation scores at 2 h after extubalion, time of awakening and extubation between two groups（P 〉 0.05）. Conclusions： Dexmedetomidine combined with propofol was beneficial to stabilize the systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） stable and Fromme Operative field quality scores during the endoscopic pituitary surgery.