右美托咪定与丙泊酚用于鼻内镜手术麻醉临床效果观察

Clinical Effects of Dexmedetomidine and Propofol for Anesthesia in Endonasal Surgery

目的:对比右美托咪定与丙泊酚用于鼻内镜手术麻醉对术中出血量及麻醉恢复质量影响。方法:选取2021年6月—2021年12月厦门大学附属第一医院耳鼻喉科择期行鼻内镜手术的60例患者作为研究对象,利用随机等比法分为右美托咪定组(D组)与丙泊酚组(P组),每组各30例。麻醉诱导后D组采用右美托咪定0.2~0.5μg/(kg·h)泵注进行麻醉维持,而P组采用丙泊酚靶血药浓度3.0~6.0μg/mL泵注。比较两组患者的麻醉情况,手术情况,在手术完成(T_(1))、睁眼(T_(2))、拔管(T_(3))及拔管后1 min(T_(4))、5 min(T_(5))、10 min(T_(6))的平均动脉压(MAP)与心率,T_(4)、T_(5)、T_(6)及拔管后20 min(T_(7))、30 min(T_(8))、40 min(T_(9))时的躁动及疼痛情况,拔管后丙泊酚或芬太尼的应用及恶心呕吐情况。结果:D组患者呛咳中位数评分为1分,平均出血量为(200.9±30.1)mL,术野质量中位数评分为4分;P组患者呛咳中位数评分为2分,平均出血量为(196.8±29.5)mL,术野质量中位数评分为5分。D组患者T_(1)、T_(2)、T_(3)、T_(4)、T_(5)、T_(6)的心率明显低于P组,差异有统计学意义(t=2.305、2.386、2.451、2.785、2.575、2.466,P<0.05)。D组T_(4)、T_(5)、T_(6)、T_(7)躁动及疼痛率明显低于P组,差异有统计学意义(χ^(2)=0.5192、4.812、5.455、4.043、5.455、6.667、5.455、5.963,P<0.05)。D组拔管后丙泊酚或芬太尼的应用明显少于P组,差异有统计学意义(P<0.05)。结论:与丙泊酚比较,右美托咪定联合瑞芬太尼与七氟烷用于鼻内镜手术麻醉,可以明显减轻拔管时呛咳反应,降低术后躁动发生率,减少疼痛发生。

Objective:To compare the effects of dexmedetomidine and propofol for anesthesia in endonasal surgery on intraoperative bleeding and quality of recovery from anesthesia.Methods:60 patients who underwent elective nasal endoscopic surgery of the hospital from Jun.to Dec.2021 were selected for the study and were randomly equated into dexmedetomidine group(Group D)and propofol group(Group P).After induction of anesthesia,group D was pumped with dexmedetomidine 0.2~0.5μg/(kg-h)for anesthesia maintenance,whereas group P was pumped with propofol target blood levels of 3.0~6.0μg/mL.The anesthetic conditions,surgical conditions,mean arterial pressure(MAP)and heart rate(HR)at the completion of surgery(T_(1)),eye opening(T_(2)),extubation(T_(3))and 1 min(T_(4)),5 min(T_(5)),10 min(T_(6))after extubation,agitation and pain at T_(4),T_(5),T_(6) and 20 min(T_(7)),30 min(T_(8)),40 min(T_(9))after extubation,application of propofol or fentanyl after extubation,and nausea and vomiting were compared between the two groups.Results:Patients in group D had a median choking score of 1,a mean bleeding volume of(200.9±30.1)mL,and a median field quality score of 4.Patients in group P had a median choking score of 2,a mean bleeding volume of(196.8±29.5)mL,and a median field quality score of 5.The HRs of T_(1),T_(2),T_(3),T_(4),T_(5),and T_(6) of patients in group D were significantly lower than those of group P,and the difference was statistically significant(t=2.305,2.386,2.451,2.785,2.575,2.466;P<0.05).The rates of T_(4),T_(5),T_(6) and T_(7) agitation and pain in group D were significantly lower than those in group P,and the difference was statistically significant(χ^(2)=0.5192,4.812,5.455,4.043,5.455,6.667,5.455,5.963;P<0.05).The application of propofol or fentanyl after extubation in group D was significantly less than that in group P,and the difference was statistically significant(P<0.05).Conclusion:Dexmedetomidine combined with remifentanil and sevoflurane for anesthesia for nasal endoscopic surgery significantly reduces the choking response during extubation,decreases the incidence of postoperative agitation,and reduces the occurrence of pain when compared with propofol.