复方阿替卡因应用于经鼻内镜下鼻腔泪囊造口术中的临床研究

Clinical effect of compound articaine in endoscopic endonasal dacryocystorhinostomy

目的:观察复方阿替卡因(必兰)浸润麻醉在经鼻内镜辅助下鼻腔泪囊造口(endoscopic endonasal dacryocystorhinostomy,EN-DCR)联合支架植入术中的效果。方法:采取前瞻性研究,选取需行经鼻内镜下左侧鼻腔泪囊造口术患者共 69 名,随机分为对照组 30 例以 2%利多卡因浸润麻醉及实验组 39 例以复方阿替卡因行浸润麻醉,比较 2 组的麻醉显效率、术中疼痛程度和术前后心率血压及术中出血情况,采用卡方检验及独立样本 t 检验的方法进行统计分析。结果:实验组和对照组的疼痛视觉模拟评分(visual analogue scale of pain,VASp)分别为(44.36±11.65) mm 和(52.67±12.02) mm,2 组间差异有统计学意义(t=2.897,P=0.005);2 组患者术中出血量比较,实验组为(3.87±0.95) mL,对照组为(4.17±0.95) mL,差异有统计学意义(t=2.698, P=0.007);实验组麻醉显效率为 89.74%,与对照组的 76.67%相比差异无统计学意义(χ^2=1.298,P=0.255)。术前、术后血压及心率的比较,差异无统计学意义(P>0.05)。结论:复方阿替卡因应用于经鼻内镜下鼻腔泪囊造口联合支架植入术中,效果可靠,是一种替代 2%利多卡因浸润麻醉的改良局部麻醉药物。

Objective:To investigate the clinical effect of compound articaine(Primacaine) for infiltration anesthesia in endoscopic endonasal dacryocystorhinostomy(EN-DCR) combined with stent implantation. Methods:A prospective study was performed for 69 patients who planned to undergo EN-DCR in the left nasal cavity,and these patients were randomly divided into control group with 30 patients(2% lidocaine for infiltration anesthesia) and experimental group with 39 patients (compound articaine for infiltration anesthesia). The two groups were compared in terms of effective proportion,visual analogue scale of pain(VASp) during surgery,preoperative/postoperative heart rate and blood pressure,and intraoperative bleeding. The chi-square test and the independent samples t-test were used for statistical analysis. Results:There were significant differences between the experimental group and the control group in VASp score(44.36±11.65 vs. 52.67±12.02,t=2.897,P=0.005) and intraoperative blood loss[(3.87±0.95) mL vs.(4.17±0.95) mL, t=2.698,P=0.007]. There was no significant difference in effective proportion between the experimental group and the control group(89.74% vs. 76.67%,χ^2 =1.298,P=0.255). There were also no significant differences between the two groups in blood pressure and heart rate before and after surgery(P>0.05). Conclusion:Compound articaine has a reliable effect in EN-DCR combined with stent implantation and is a modified local anesthetic which can replace 2% lidocaine for infiltration anesthesia.