不同剂量右美托咪定在DTRS鼻内镜手术全身麻醉中的应用

Application of Different Doses Dexmedetomidine in DTRS Nasal Endoscopic Surgery General Anesthesia

目的:探讨不同剂量右美托咪定(Dexmedetomidine,Dex)在难治性鼻-鼻窦炎(difficult-to-treat rhinosinusitis,DTRS)鼻内镜手术全身麻醉中的应用。方法:选取2020年7月-2022年4月揭西县中医医院鼻内镜手术治疗的120例DTRS患者为研究对象。根据随机数字表法将其分为A、B、C组,各40例。三组均给予全身麻醉。A、B、C组麻醉诱导前分别给予0.2、0.4、0.6μg/kg的Dex。比较三组入室时(T_(0))、麻醉诱导前15 min(T_(1))、插管后即刻(T_(2))、苏醒时(T_(3))血流动力学指标,疼痛情况,麻醉效果及不良反应。结果:T_(0)时,三组平均动脉压(MAP)和心率(HR)比较差异均无统计学意义(P>0.05),T_(1)、T_(2)时,A组的MAP和HR水平均高于B组和C组(P<0.05),T_(3)时,三组MAP和HR比较差异均无统计学意义(P>0.05),三组T_(0)、T_(1)、T_(2)、T_(3)时血氧饱和度(SpO_(2))比较差异无统计学意义(P>0.05)。三组术中镇痛满意度比较差异无统计学意义(P>0.05)。A组拔管时间、苏醒时间、定向力恢复时间均早于B、C组(P<0.05)。A组不良反应发生率明显低于B、C组(P<0.05)。结论:低剂量Dex(0.2μg/kg)可显著降低患者不良反应发生率,明显提高麻醉效果,进而极大地提高手术疗效和改善患者预后。

Objective:To discuss the application of different doses Dexmedetomidine(Dex)in difficult-to-treat rhinosinusitis(DTRS)nasal endoscopic surgery general anesthesia.Method:From July 2020 to April 2022,120 patients with DTRS treated by nasal endoscopic surgery in Jiexi County Hospital of Traditional Chinese Medicine were selected as the research objects.According to the method of random number table,they were divided into group A,B and C,40 cases in each group.All three groups were given general anesthesia.Groups A,B and C were given 0.2,0.4 and 0.6μg/kg of Dex before induction of anesthesia respectively.The hemodynamic indexes at admission(T_(0)),15 minutes before anesthesia induction(T_(1)),immediately after intubation(T_(2)),and when awake(T_(3)),pain condition,anesthetic effect and adverse reactions were compared among the three groups.Result:At T_(0),there were no significant differences in mean arterial pressure(MAP),heart rate(HR)in the three groups(P>0.05).At T_(1),T_(2),the MAP and HR levels in group A were higher than those in group B and group C(P<0.05).At T_(3),there were no significant differences in MAP and HR in the three groups(P>0.05).There were no significant differences in blood oxygen saturation(SpO_(2))at T_(0),T_(1),T_(2),T_(3) in the three groups(P>0.05).There was no significant difference in analgesia satisfaction among the three groups(P>0.05).The extubation time,awakening time and recovery time of orientation force in group A were earlier than those in groups B and C(P<0.05).The incidence of adverse reactions in group A was significantly lower than that in groups B and C(P<0.05).Conclusion:Low-dose Dex(0.2μg/kg)can significantly reduce the incidence of adverse reactions,significantly improve the anesthetic effect,and thus greatly improve the surgical efficacy and prognosis of patients.