七氟醚联合右美托咪定在口腔颌面外科正颌手术中的应用

Application of sevoflurane combined with dexmedetomidine in orthognathic surgery in oral and maxillofacial surgery

目的探讨七氟醚联合右美托咪定在口腔颌面外科正颌手术中的应用及安全性,为临床应用提供依据。方法选取2017年1月至2019年8月期间我院口腔颌面外科就诊并且行正颌手术的全麻患者共60例,随机分为试验组和对照组,每组30例。试验组在七氟醚维持麻醉基础上加用右美托咪定注射液,维持术中平均动脉压(MAP)55~65 mmHg。记录两组患者诱导麻醉即刻、气管插管时、手术不同时间点的HR和MAP;记录两组患者手术时间、达目标MAP时间、出血量、瑞芬太尼用量、术野质量以及两组患者术后躁动情况及麻醉相关不良事件发生情况。结果麻醉后,试验组T_3~T_9时间段的MAP及T_2~T_8时间段的HR水平低于对照组(P<0.05);试验组达目标MAP时间、出血量、瑞芬太尼用量少于对照组(P<0.05);两组患者手术时间比较差异无统计学意义(P>0.05);两组患者视野评分均在1~3分之间,试验组T_2、T_4、T_6、T_8时刻视野评分1级和2级患者数量多于对照组(P<0.05);试验组、对照组躁动及不良事件发生总例数分别为3例(10.0%)、9例(30.0%),两组比较差异有统计学意义(P<0.05)。结论正颌外科手术全麻过程中,采用七氟醚联合右美托咪定,能够稳定血流动力学指标,减少MAP达标时间,降低出血量,提高术野质量,降低躁动情况及全麻相关不良事件发生率,具有良好的安全性,值得临床推广应用。

Objective To explore the application and safety of sevoflurane combined with dexmedetomidine in orthognathic surgery in oral and maxillofacial surgery,and to provide basis for clinical application.Methods A total of 60 patients undergoing orthognathic surgery under general anesthesia in oral and maxillofacial surgery in our hospital from January 2017 to August 2019 were randomly divided into experimental group and control group,with 30 cases in each group.Experimental group was given dexmedetomidine injection on the basis of sevoflurane maintenance anesthesia to maintain the mean intraoperative arterial pressure(MAP)of 55~65 mmHg.HR and MAP were recorded at the time of induction of anesthesia and tracheal intubation,and at different time points of operation.The operation time,the time of reaching the target MAP,the amount of bleeding,the dosage of remifentanil,the quality of operation field,the restlessness of patients and the occurrence of anesthesia-related adverse events were recorded.Results After anesthesia,MAP in T3~T9 period in experimental group was lower than that in control group,and HR in T2~T8 period in experimental group was lower than that in control group(P<0.05);the time of reaching the target MAP,the amount of bleeding and the amount of remifentanil used in experimental group were less than those in control group(P<0.05);there was no significant difference in the operation time between the two groups(P>0.05);the visual field scores of the two groups were between 1 and 3 points,and the number of patients with grade 1 and 2 visual field scores at T2,T4,T6 and T8 in experimental group was more than that in control group(P<0.05);the total number of restlessness and adverse events in experimental group and control group were 3(10.0%)and 9(30.0%)respectively,the difference between the two groups was statistically significant(P<0.05).Conclusion During general anesthesia in orthognathic surgery,sevoflurane combined with dexmedetomidine can stabilize hemodynamic parameters,reduce the time of MAP reach to the standard,reduce the amount of bleeding,improve the quality of surgical field,and reduce restlessness and the incidence of adverse events related to general anesthesia.It is safe and worthy of clinical application.