右美托咪定加单次小剂量肌松全身麻醉在鼻内窥镜手术ERAS中应用

Application of dexmedetomidine combined with single and low dose of muscle relaxant for general anesthesia in ERAS of nasal endoscopic surgery

目的探讨右美托咪定加单次小剂量肌松全身麻醉在鼻内窥镜手术ERAS中的应用效果。方法选择2018年5月~2019年4月本院收治的拟择期行鼻内窥镜手术患者30例,男16例,女14例,随机分为两组,每组各15例。观察组麻醉诱导采用右美托咪定0.5μg/kg缓慢静注、丙泊酚2 mg/kg,罗库溴铵0.8 mg/kg、芬太尼1μg/kg,全麻插管控制呼吸。麻醉维持:丙泊酚50~60μg/(kg·min),瑞芬太尼0.3μg/(kg·min)行麻醉维持,不再使用右美托咪定及肌松剂。对照组采用常规麻醉方法,手术结束麻醉停药后,待患者意识清醒,TOF≥0.9时,拔除气管导管,10 min内MAS≥9分,送入外科病房,达不到出室条件患者送入PACU。术中监护HR、MAP,术毕停药后,记录患者命令反应时间、拔管时间、MAS≥9时间、有无EA。结果两组HR、MAP改变比较,差异无统计学意义(P>0.05),观察组术后各项苏醒指标分别为命令反应时间为(2.5±1.1)min、拔管时间为(2.8±1.0)min、MAS≥9时间为(4.5±2.1)min,与对照组比较,差异有统计学意义(P<0.01)。无EA发生,全部患者术后5 min内达到出室条件。对照组患者10 min内全部没有达到MAS≥9,送入PACU,7例(46.7%)发生EA。两组无其他麻醉相关并发症。结论右美托咪定加单次小剂量肌松全麻在鼻内窥镜手术ERAS中应用与常规全麻比较,效果明显,无须进入PACU,无EA发生,有临床推广价值。

Objective To explore the application efficacy of dexmedetomidine combined with single and low dose of muscle relaxant for general anesthesia in ERAS of nasal endoscopic surgery.Methods A total of 30 patients(16 males and 14 females were included)who were scheduled to undergo nasal endoscopic surgery and admitted to our hospital from May 2018 to April 2019 were randomLy divided into the observation group(n=15)and the control group(n=15).In the observation group,0.5μg/kg dexmedetomidine,2 mg/kg propofol,0.8 mg/kg rocuronium and 1 ug/kg fentanyl were used for anesthesia induction,and general anesthesia intubation was used to control breathing.In the anesthesia maintenance,50-60μg/(kg·min)propofol and 0.3μg/(kg·min)remifentanil were used,while dexmedetomidine and muscle relaxant were no longer used.On the other hand,the conventional anesthesia was used in the control group.After the anesthesia was stopped after the operation,when the patient was conscious and TOF≥0.9,the endotracheal tube was removed.Within 10 minutes,when MAS≥9 points,the patient was sent to the surgical ward,and if he could not meet the condition of discharge,he would be sent to PACU.HR and MAP were monitored during operation.After stopping the drug after operation,the patient′s reaction time on command,extubating time,MAS≥9 time and with or without EA were recorded.Results There were no significant differences in HR and MAP changes between the two groups.The wake-up indexes in the observation group were(2.5±1.1)min after operation,(2.8±1.0)min after extubating,and(4.5±2.1)min after MAS≥9.Compared with the control group,there was statistically significant difference(P<0.01).No EA occurred,and all patients reached the discharge condition within 5 min after operation.None of the patients in the control group reached MAS≥9 within 10 minutes.And after they were sent to PACU,EA occurred in 7 patients(46.7%).There was no other anesthesia related complications in the two groups.Conclusion Compared with conventional general anesthesia,dexmedetomidine combined with a single and low dose of muscle relaxant for general anesthesia has obvious efficacy.There is no need to enter PACU,no EA occurs.Therefore,it is worthy of clinical promotion.