右美托咪定用于鼻内镜手术对控制性降压和苏醒期躁动的影响

Effect of Dexmedetomidine on Endoscopic Sinus Surgery for Controlled Hypotension and Emergence Agitation

目的分析静-吸复合麻醉下鼻内镜手术中右美托咪定对控制性降压和苏醒期躁动的临床价值.方法选取2018年2~10月于徐州医科大学附属医院择期行鼻内镜手术患者为研究对象,根据数字表法随机分为右美托咪定组(D组)和对照组(C组),各50例.D组于麻醉诱导前10min给予0.5μg/kg负荷量的右美托咪定,并以0.5μg/(kg·h)的速度持续泵注至手术结束前5min.C组以相同方式给予等容积的0.9%NaCl溶液.比较两组不同时间点HR、MAP、Fromme术野评分(SSFQ)、术中出血量、七氟醚的使用浓度、麻醉时间、手术时间及控制性降压时间、患者气管导管拔除后Ricker镇静躁动评分(SAS)、疼痛视觉模拟评分(VAS)、恶心、呕吐评分、术后1天及3天麻醉恢复质量评分(QoR-40)、住院时间及术后不良反应发生率.结果两组患者各时刻的MAP、HR比较,差异无统计学意义(P>0.05).与C组比较,D组在T7、T8时刻七氟醚使用浓度和SSFQ方面比较,差异有统计学意义(P<0.05).D组术中出血量显著低于C组(110ml vs 140ml,P<0.05).两组在T5、T6时刻的七氟醚使用浓度和SSFQ、拔管后SAS、VAS、恶心、呕吐评分、麻醉时间、手术时间、降压时间、PACU停留时间、术中补液量、术中高血压发生例数、术中阿托品使用例数、术后1天及3天QoR-40评分、住院时间、术后不良反应发生率方面比较,差异无统计学意义(P>0.05).结论右美托咪定复合七氟醚控制性降压在鼻内镜手术中安全可行,改善苏醒质量,且不延长苏醒时间.

Objective To analyze the clinical value of dexmedetomidine in the control of hypotension and recovery in endoscopic sinus surgery under static-suction combined anesthesia.Methods Patients who underwent endoscopic sinus surgery at the Xuzhou Medical University Affiliated Hospital from February 2018 to October 2018 were selected as subjects.They were divided into dexmedetomidine group(group D)and control group according to random number method(group C),with 50 cases each.Group D was given dexmedetomidine at a dose of 0.5μg/kg lOmin before anesthesia induction,and dexmedetomidine was continuously pumped at a rate of 0.5μg/(kg·h)until 5min before the end of surgery.Group C was given an equal volume of physiological saline at the same time.The HR,MAP,Fromme field score(SSFQ),intraoperative blood loss,sevoflurane concentration,anesthesia time,operation time and controlled hypotensive time were compared between the two groups at different time points.Ricker sedation and sedation score(SAS),pain visual analogue scale(VAS),and nausea and vomiting scores were compared after tracheal extubation in both groups.The anesthesia recovery quality score(QoR-40)of 1 day and 3 days after operation was compared.The hospitalization time and the incidence of postoperative adverse reaction were compared between the two groups.Results There was no significant difference in MAP and HR between the two groups at each time(P>0.05).Compared with group C,group D had significant differences in sevoflurane use concentration and SSFQ at T7 and T8(P<0.05).The amount of intraoperative blood loss in group D was significantly lower than that in group C(110ml vs 140ml,P<0.05).There were no significant differences in the concentrations of sevoflurane and SSFQ at the time of T5 and T6,SAS,VAS after extubation,nausea and vomiting score,anesthesia time,operation time,and PACU stay time,the amount of intraoperative fluid replacement,the number of intraoperative hypertension,the number of intraoperative atropine used,the 1-day and 3-day QoR-40 scores,the length of hospital stay,and the incidence of postoperative adverse reactions(P>0.05).Conclusion The controlled decompression of dexmedetomidine combined with sevoflurane is safe and feasible in endoscopic sinus surgery,and does not prolong the recovery time and improve the quality of recovery.