右美托咪定复合羟考酮对鼻内镜手术患者围术期拔管应激反应的影响

Effects of dexmedetomidine combined with oxycodone on perioperative extubation stress response in patients with nasal endoscopic surgery

目的观察右美托咪定复合羟考酮对鼻内镜手术患者围术期拔管应激反应的影响。方法将择期行鼻内镜手术的60例患者随机分为舒芬太尼组和羟考酮组,每组30例。舒芬太尼组给予0.4μg/kg舒芬太尼和0.5~0.6μg/kg右美托咪定麻醉诱导,羟考酮组给予0.2 mg/kg羟考酮和0.5~0.6μg/kg右美托咪定麻醉诱导。于麻醉诱导前(T0)、气管插管后1 min(T1)、手术开始时(T2)、拔管时(T3)、拔管后10 min(T4)记录所有患者平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、皮质醇(cortisol,COR)、血糖(blood glucose,GLU)水平,比较2组唤醒时间、拔管时间、拔管质量评分、Ramsay镇静评分及不良反应发生情况。结果2组MAP、HR、COR、GLU呈先升高再降低趋势,羟考酮组MAP、HR、COR、GLU变化幅度明显低于舒芬太尼组,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。羟考酮组拔管质量评分明显低于舒芬太尼组,Ramsay镇静评分明显高于舒芬太尼组,不良反应发生率低于舒芬太尼组,差异均有统计学意义(P<0.05)。2组唤醒时间、拔管时间差异均无统计学意义(P>0.05)。结论右美托咪定复合羟考酮麻醉诱导用于鼻内镜手术,可有效维持血流动力学稳定,抑制围术期拔管应激反应,降低不良反应发生率。

Objective To observe the effects of dexmedetomidine combined with oxycodone on perioperative extubation stress response in patients with nasal endoscopic surgery.Methods Sixty patients who underwent selective nasal endoscopic surgery were randomly divided into sufentanil group and oxycodone group,with 30 cases in each group.Sufentanil group was given 0.4μg/kg sufentanil and 0.5-0.6μg/kg dexmedetomidine for anesthesia induction,and oxycodone group was given 0.2 mg/kg oxycodone and 0.5-0.6μg/kg dexmedetomidine for anesthesia induction.Mean arterial pressure(MAP),heart rate(HR),cortisol(COR)and blood glucose(GLU)were recorded before anesthesia induction(T0),at 1 min after tracheal intubation(T1),at the beginning of surgery(T2),at extubation(T3)and at 10 min after extubation(T4).The wake-up time,extubation time,extubation quality score,Ramsay sedation score and occurrence of adverse reactions were compared between two groups.Results The MAP,HR,COR and GLU in two groups were increased first and then decreased,and the changes of MAP,HR,COR and GLU in oxycodone group were significantly lower than those in sufentanil group,and there were statistically significant differences between-group effects,time-point effects and interaction effects of between-group and time-point(P<0.05).The extubation quality score in oxycodone group was significantly lower than that in sufentanil group while the Ramsay sedation score was significantly higher than that in sufentanil group,and the incidence rate of adverse reactions was lower than that in sufentanil group(P<0.05).There were no significant differences in wake-up time and extubation time between two groups(P>0.05).Conclusion Dexmedetomidine combined with oxycodone anesthesia induction for nasal endoscopic surgery can effectively maintain hemodynamic stability,inhibit perioperative extubation stress response,and reduce the incidence rate of adverse reactions.