右美托咪定联合瑞芬太尼、丙泊酚对腔镜下甲状腺手术的影响

Effect of Dexmedetomidine Combined with Remifentanil and Propofol on Endoscopic Thyroid Surgery

目的:探讨右美托咪定联合瑞芬太尼、丙泊酚对腔镜下甲状腺手术的影响。方法:选择2021年1月-2022年4月于江苏省江原医院进行腔镜下甲状腺手术治疗的122例患者,依照其入院先后顺序分为对照组和观察组,各61例。对照组给予瑞芬太尼和丙泊酚麻醉,观察组给予右美托咪定联合瑞芬太尼、丙泊酚麻醉。比较两组不同时间点生命体征、脑电双频指数(BIS)值、苏醒时间、自主呼吸恢复时间、拔管时间、气管导管拔除后镇静评分、气管插管时及拔管时呛咳发生情况,以及苏醒期躁动情况。结果:两组麻醉诱导前(T_(0))的心率(HR)、平均动脉压(MAP)、BIS值及自主呼吸恢复时间比较,差异无统计学意义(P>0.05);气管插管时(T_(1))、气管插管10 min(T_(2))、甲状腺切除时(T_(3))、气管导管拔除时(T_(4))观察组的HR、MAP、BIS值均低于对照组(P<0.05)。观察组的苏醒时间和拔管时间均晚于对照组(P<0.05)。气管插管时及拔管时观察组的呛咳发生率与呛咳评分均低于对照组(P<0.05)。观察组的苏醒期躁动评分低于对照组,气管导管拔除后30 min、1 h时Ramsay镇静评分均高于对照组(P<0.05)。结论:右美托咪定联合瑞芬太尼、丙泊酚可以促进腔镜下甲状腺手术患者术中生命体征和BIS稳定,有效预防腔镜下甲状腺手术呛咳发生。

Objective:To investigate the effect of Dexmedetomidine combined with Remifentanil and Propofol on endoscopic thyroid surgery.Method:A total of 122 patients who underwent endoscopic thyroid surgery in Jiangyuan Hospital of Jiangsu Province from January 2021 to April 2022 were selected,and divided into control group and observation group according to the order of admission,61 cases in each group.The control group was anesthetized with Remifentanil and Propofol,and the observation group was anesthetized with Dexmedetomidine combined with Remifentanil and Propofol.The vital signs at different time points,bispectral index(BIS)values,recovery time,spontaneous breathing recovery time,extubation time,sedation score after tracheal intubation,occurrence of coughing during endotracheal intubation and extubation,and the restlessness during awakening between the two groups were compared.Result:There were no significant differences in heart rate(HR),mean arterial pressure(MAP),BIS value and spontaneous breathing recovery time between the two groups before anesthesia induction(T_(0))(P>0.05).The HR,MAP and BIS values were lower than those in the control group at the time of endotracheal intubation(T_(1)),10 minutes intubation(T_(2)),thyroidectomy(T_(3)),and tracheal intubation(T_(4))(P<0.05).The awakening time and extubation time were later than those in the control group(P<0.05).The incidence of choking and coughing scores during tracheal intubation and extubation in the observation group were lower than those in the control group(P<0.05).The restlessness score in the observation group in the awakening period was lower than that in the control group,and Ramsay sedation score was higher than that in the control group at 30 minutes and 1 hour after tracheal tube removal(P<0.05).Conclusion:Dexmedetomidine combined with Remifentanil and Propofol can promote the stability of vital signs and BIS in patients undergoing endoscopic thyroid surgery,and effectively prevent the occurrence of cough during endoscopic thyroid surgery.