右美托咪定联合尼卡地平在鼻内镜下鼻中隔矫正术控制性降压中的应用效果

Application effect of dexmedetomidine combined with nicardipine in controlled hypotension of nasal septum correction under nasal endoscope

目的探讨鼻内镜下鼻中隔矫正术中应用右美托咪定联合尼卡地平控制性降压的效果。方法选择2020年1月至2022年6月期间在本院择期行鼻内镜下鼻中隔矫正术治疗的82例患者,随机分为对照组(n=41)和观察组(n=41),对照组使用尼卡地平控制性降压,观察组使用右美托咪定联合尼卡地平控制性降压,观察两组在不同时点的MAP、HR变化及T2时点(降压后20分钟)的Fromme术野质量评分(SSFQ),记录两组术中麻醉药和尼卡地平用量、呼吸恢复时间、拔管时间,比较两组患者入PACU时Ramsay镇静评分和VRS评分,统计两组术后不良反应发生情况。结果与T0时点相比,在T1-T3时点两组的MAP、HR均明显下降(P<0.05),在T4时点对照组的MAP、HR明显上升(P<0.05),观察组的MAP、HR变化不明显(P>0.05)。在T1-T3时点两组的MAP比较差异无统计学意义(P>0.05),观察组的HR低于对照组(P<0.05);在T4时点观察组的MAP、HR均低于对照组(P<0.05)。观察组的SSFQ评分低于对照组,尼卡地平、瑞芬太尼及丙泊酚用量均少于对照组(P<0.05)。观察组患者的拔管时间长于对照组,Ramsay镇静评分高于对照组,VRS评分低于对照组(P<0.05),但两组呼吸恢复时间比较差异无统计学意义(P>0.05)。观察组的不良反应总发生率为7.32%,低于对照组的39.02%(P<0.05)。结论右美托咪定联合尼卡地平在鼻内镜下鼻中隔矫正术控制性降压中的应用效果较好,可确保手术视野清晰,减少术中麻醉药和尼卡地平用量,提升患者苏醒舒适度,且不良反应少。

Objective To investigate the effect of dexmedetomidine combined with nicardipine in controlled hypotension of nasal septum correction under nasal endoscope.Methods A total of 82 patients who underwent elective nasal septum correction under nasal endoscope in our hospital from January 2020 to June 2022 were selected and randomly divided into control group(n=41)and observation group(n=41).The control group received nicardipine for controlled hypotension,while the observation group received dexmedetomidine combined with nicardipine for controlled hypotension.The changes in MAP and HR at different time points and the Fromme surgical field quality score(SSFQ)at T2(20 minutes after blood pressure reduction)were observed in the two groups.The dosages of intraoperative anesthetic and nicardipine,respiratory recovery time,and extubation time were recorded in the two groups.The Ramsay sedation score and VRS score were compared between the two groups when they entered the PACU,and the incidence of postoperative adverse reactions in the two groups was counted.Results Compared with T0,the MAP and HR of the two groups decreased significantly at T1-T3(P<0.05),the MAP and HR of the control group increased significantly at T4(P<0.05),and the MAP and HR of the observation group did not change significantly at T4(P>0.05).There was no significant difference in MAP between the two groups at T1-T3(P>0.05),and the HR of the observation group was lower than that of the control group at T1-T3(P<0.05).The MAP and HR of the observation group were lower than those of the control group group at T4(P<0.05).The SSFQ score of the observation group was lower than that of the control group,and the dosages of nicardipine,remifentanil and propofol were all lower than those of the control group(P<0.05).The extubation time of the observation group was longer than that of the control group,the Ramsay sedation score of the observation group was higher than that of the control group,and the VRS score of the observation group was lower than that of the control group(P<0.05),but there was no significant difference in the respiratory recovery time between the two groups(P>0.05).The total incidence of adverse reactions in the observation group was 7.32%,which was lower than 39.02%in the control group(P<0.05).Conclusion Dexmedetomidine combined with nicardipine has a good effect in controlled hypotension of nasal septum correction under nasal endoscope,which can ensure a clear surgical field,reduce the dosages of intraoperative anesthetics and nicardipine,improve the recovery comfort of patients,and have fewer adverse reactions.