右美托咪定在鼻内镜术控制性降压中的应用观察

Observation of the application of dexmedetomidine in controlled hypotension during endoscopic sinus surgery

目的比较右美托咪定复合尼卡地平及单独应用尼卡地平在鼻内镜术中控制性降压的效果。方法选取承德医学院附属医院2017年5月~2018年1月收治的美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级择期行鼻内镜术的患者60例,随机数表法分为右美托咪定复合尼卡地平组(DN组),尼卡地平组(N组),每组30例。麻醉诱导前15 min,DN组静脉注射右美托咪定1μg/kg,后以0.3μg/(kg·h)的速率持续泵入,N组给予等量生理盐水。手术开始时两组均泵入尼卡地平,起始药物速率均为2μg/(kg·min),术中目标平均动脉压(MAP)维持在60~70 mmHg,依据MAP调整尼卡地平药物剂量。两组均以丙泊酚、瑞芬太尼维持麻醉,维持脑电双频指数(BIS)值在40~60。手术结束鼻腔填塞时,停用所有药物。采集麻醉前(T0)、降压至目标血压时(T1)、降压30 min(T2)、停药时(T3)、停药后20 min(T4)的MAP、心率(HR)、眼压(IOP),T0、T4时刻动脉血进行血气分析。记录乳酸值、术野质量评分、出血量,丙泊酚、瑞芬太尼用量,呼吸恢复时间、拔管时间、VRS疼痛评分和镇静评分及不良反应。结果降压期间DN组HR、丙泊酚及瑞芬太尼用量、VRS评分、不良反应的发生率低于N组,差异有统计学意义(P<0.05);T4时DN组MAP、HR、IOP均低于N组,差异有统计学意义(P<0.05);DN组气管拔管时间、Ramsay评分高于N组,差异有统计学意义(P<0.05)。结论两组药物均可获得良好术野质量,右美托咪定可显著降低阿片类镇痛药和镇静药用量,不良反应少,适合应用于鼻内镜手术的控制性降压。

Objective To compare the effects of dexmedetomidine combined with nicardipine and nicardipine alone on controlling blood pressure during nasal endoscopy.Methods Sixty patients with ASA I-II selective nasal endoscopy were randomly divided into dexmedetomidine combined with nicardipine group(DN group),nicardipine group(N group),n=30 in each group.Fifteen minutes before anesthesia induction,dexmedetomidine was intravenously injected at a rate of 1μg/kg in DN group,and then was continuously pumped at a rate of 0.3μg/kg.h.Same volume of saline was given in N group.At the beginning of the operation,nicardipine was infused in both groups at the initial rate of 2μg/(kg.min).During the operation,the target MAP was maintained at60~70 mmHg.The dosage of nicardipine was adjusted according to the MAP.Both groups,anesthesia were maintained with propofol and remifentanil,and the BIS value was 40-50.All drugs were discontinued at the end of the operation.MAP,HR,IOP were recorded before anesthesia(T0),at the time of target blood pressure(T1),at the time of 30 minutes after target blood pressure(T2),at the time of discontinuing all the drugs(T3),at the time of 20 minutes after discontinuing of all the drugs(T4),and blood gas analysis.Lactic acid value,field quality score,bleeding volume,propofol,remifentanil dosage,respiratory recovery time,extubation time,VRS pain score,sedation score and adverse reactions were recorded at the time of T0 and T4.Results HR,propofol and remifentanil dosage,VRS score and adverse reactions in DN group were lower than those in N group during(P<0.05),controlling blood pressure and MAP,HR and IOP in DN group were lower than those in N group at T4(P<0.05).The time of tracheal extubation and Ramsay score in DN group were higher than those in N group(P<0.05).Conclusion Good surgical field could be obtained in both groups.Dexmedetomidine can significantly reduce the dosage of opioid analgesics and sedatives,with fewer adverse reactions.It is suitable for controlling blood pressure in nasal endoscopic surgery.