低剂量右美托咪定复合丙泊酚联合舒芬太尼在面部整形术中的应用效果分析

Application Effect of Low-dose Dexmedetomidine Combined with Propofol and Sufentanil in Facial Plastic Surgery

目的:探究低剂量右美托咪定复合丙泊酚联合舒芬太尼用于面部整形手术的临床效果。方法:前瞻性选择2018年8月-2019年10月在中国医学科学院北京协和医学院整形外科医院就诊后接受面部整形手术的患者60例。将全部患者根据随机数字表法分为对照组以及观察组,每组30例。对照组使用丙泊酚联合舒芬太尼进行麻醉,观察组使用右美托咪定+丙泊酚联合舒芬太尼进行麻醉。对比两组血流动力学指标[麻醉诱导前,麻醉后15min,手术开始,手术完成时的平均动脉压(MAP)、心率(HR)、动脉血氧分压(SpO2)],术后苏醒时间,术后清醒时间,视觉模拟评分(Visual analog scale,VAS),镇静评分(Ramsay评分),术中体动次数和舒芬太尼追加使用剂量,麻醉恢复室内不良反应发生率以及手术医生、麻醉医生、患者的满意度。结果:两组麻醉诱导前、麻醉后15min、手术开始、手术完成时的MAP、HR、SpO2比较差异均不具有统计学意义(P>0.05)。观察组的术后苏醒时间、术后清醒时间均短于对照组,差异有统计学意义(P<0.05)。观察组术后的VAS评分、镇静评分高于对照组,差异有统计学意义(P<0.05)。观察组术中体动次数和舒芬太尼追加使用剂量均低于对照组,差异有统计学意义(P<0.05)。两组在麻醉恢复室内不良反应发生率比较差异不具有统计学意义(P>0.05)。且两组手术医生、麻醉医生、患者满意度比较差异不具有统计学意义(P>0.05)。结论:接受面部整形手术的患者,采用低剂量右美托咪定复合丙泊酚的麻醉方法,可保证手术过程中血流动力学的稳定,并有助于缩短术后清醒时间,改善术后的镇静效果,并且安全性良好。

Objective To explore the clinical effect of low-dose dexmedetomidine combined with propofol and sufentanil in facial plastic surgery.Methods Prospective selection of 60 patients who underwent facial plastic surgery in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College from August 2018 to October 2019.According to the method of random number table,all patients were divided into the control group and the observation group with the same number of people.The number of patients in each group was 30 cases.The control group was anesthetized with propofol combined with sufentanil,and the observation group was anesthetized with dexmedetomidine+propofol combined with sufentanil.Compared the hemodynamic indexes of the two groups[before induction of anesthesia,15min after anesthesia,start of the operation,mean arterial pressure(MAP),heart rate(HR),arterial partial pressure of oxygen(SpO2)at the completion of the operation],and wake up after operation time,postoperative awake time,visual analog scale(VAS),sedation score(Ramsay score),intraoperative body movements,additional doses of sufentanil,adverse reactions in the anesthesia recovery room,surgeon satisfaction,anesthesia doctor's satisfaction,patient's satisfaction.Results There were no statistically significant differences in the MAP,HR,and SpO2 of the two groups of patients before induction of anesthesia,15 minutes after anesthesia,the beginning of the operation,and the completion of the operation(P>0.05).The postoperative wake-up time and postoperative awake time of the observation group were shorter than those of the control group,the differences were statistically significant(P<0.05).The postoperative VAS score and the sedation score were higher than those of the control group(P<0.05).The number of body movements and the additional dose of sufentanil in the observation group were lower than those in the control group(P<0.05).The difference in the incidence of adverse reactions in the anesthesia recovery room between the two groups was not statistically significant(P>0.05).There was no statistically significant difference in satisfaction data between the two groups of surgeons,anesthesiologists,and patient’s(P>0.05).Conclusion For patients undergoing facial plastic surgery,the use of low-dose dexmedetomidine combined with propofol anesthesia can ensure the stability of hemodynamics during the operation,and help to shorten the postoperative wakefulness time and improve postoperative sedation Painful effect and good safety.