右美托咪定滴鼻在白内障超声乳化手术中的镇静效果

Sedative effect of Dexmedetomidine nasal dropping in phacoemulsification of cataract

目的探讨右美托咪定滴鼻在白内障超声乳化手术中的镇静效果。方法选取2021年1月至12月南京医科大学附属江苏盛泽医院眼科中心的100例行日间择期白内障超声乳化手术患者作为研究对象,按照随机数字表法分为D组(n=50)和C组(n=50)。D组患者手术前30 min采用右美托咪定0.5μg/kg稀释到2 ml滴鼻;C组在同样时间采用0.9%氯化钠2 ml滴鼻,两组患者术前皆采用0.5%盐酸丙美卡因滴眼液表面麻醉后实施白内障超声乳化术。以术前门诊检查时测得的三次血压、心率的平均值作为其基础值(T0),记录并比较两组患者术前(T1)、术中(T2)、术毕(T3)的血压、心率、镇静评分、术中镇痛评分以及术后医生对患者术中配合程度的评价。结果D组患者T1、T2、T3的平均动脉压、心率、双乘积(RPP)与本组T0时比较,差异无统计学意义(P>0.05);C组T1、T2、T3时的平均动脉压、心率、RPP高于本组T0时,差异有统计学意义(P<0.05);D组T1、T2时的心率和平均动脉压低于C组,差异有统计学意义(P<0.05);D组T1、T2、T3时的RPP低于C组,差异有统计学意义(P<0.05)。D组术中的Ramsay镇静评分低于C组,差异有统计学意义(P<0.05)。两组患者术中视觉模拟评分(VAS)比较,差异无统计学意义(P>0.05)。D组患者术中配合度高于C组,差异有统计学意义(P<0.05)。结论右美托咪定滴鼻作为白内障超声乳化手术的术前用药,能够在术中起到明显镇静作用,且术中循环更稳定,有利于患者配合手术。

Objective To investigate the sedative effect of Dexmedetomidine nasal dropping in phacoemulsification of cataract.Methods A total of 100 patients undergoing daytime selective cataract phacoemulsification in the Department of Ophthalmology of Jiangsu Shengze Hospital Affiliated to Nanjing Medical University from January to December 2021 were selected as research objects,they were divided into group D(n=50)and group C(n=50)according to random number table method.Patients in group D received 0.5μg/kg Dexmedetomidine nasal dropping 30 min before surgery.Group C received 0.9%Sodium Chloride 2 ml at the same time,and both groups were droped 0.5%Proparacaine Hydrochloride in eye before cataract phacoemulsification.The average values of blood pressure and heart rate measured three times in the preoperative outpatient examination were taken as the basic values(T0),and the blood pressure,heart rate at preoperative(T1),intraoperative(T2),and postoperative(T3),sedation score,intraoperative analgesia score and postoperative doctor's evaluation of patients'intraoperative cooperation were recorded and compared between the two groups.Results There were no significantly differences in mean arterial pressure,heart rate and heart rate-blood pressure product(RPP)of group D among T0,T1,T2 and T3(P>0.05).The mean arterial pressure,heart rate and RPP of group C at T1,T2 and T3 were higher than those at T0,the differences were statistically significant(P<0.05).The mean arterial pressure and heart rate of group D at T1, T2 were lower than those of group C, the differences were statistically significant (P<0.05). The RPP of group D at T1, T2 and T3 were lower than those of group C, the differences were statistically significant (P<0.05). The intraoperative Ramsay sedation score of group D was lower than that of group C, the difference was statistically significant (P<0.05). There was no significantly difference in visual analogue scale (VAS) score between the two groups (P>0.05). The degree of patients' intraoperative cooperation in group D was higher than that of group C, the difference was statistically significant (P<0.05). Conclusion Dexmedetomidine nasal dropping as a preoperative drug for cataract phacoemulsification, can play a significant sedative role during the operation, and the circulation during the operation is more stable, which is conducive to the patient's cooperation with the operation.