右美托咪定复合异丙酚和瑞芬太尼在面部整形麻醉中的应用

Application of Dexmedetomidine Combined with Propofol and Remifentanil in Facial Plastic Anesthesia

目的:探究右美托咪定复合异丙酚和瑞芬太尼在面部整形麻醉中的应用效果。方法:回顾性选取笔者医院2021年1月-2021年12月收治的240例择期面部整形患者的临床资料,根据麻醉方式分两组,对照组(n=123)入室后给予3.6μg/kg/h的生理盐水,观察组(n=117)泵注等量右美托咪定,10 min后将泵注速度调整为0.3μg/kg/h,术中两组靶控输注异丙酚与瑞芬太尼。比较两组麻醉前15 min(T1)、插管后2 min(T2)、手术开始时(T3)、手术30 min时(T4)、拔除气管导管时(T5)的平均动脉压(MAP)、心率(HR)、围术期药物靶质量浓度、麻醉恢复各指标情况及不良反应发生情况。结果:两组MAP、HR时间、组间、交互效应比较差异有统计学意义(P<0.05);两组T1时MAP、HR,T4时HR比较差异均无统计学意义(P>0.05),观察组T2~T5时MAP,T2、T3、T5时HR均低于对照组(P<0.05);观察组异丙酚及瑞芬太尼靶质量浓度低于对照组(P<0.05);两组定向力恢复时间、麻醉恢复室(PACU)停留时间、自主呼吸恢复时间比较差异无统计学意义(P>0.05);观察组气管拔管后10 min时的Richmond镇静-躁动(RASS)评分低于对照组(P<0.05);两组围术期发生的不良反应包括呕吐、窦性心动过缓、呛咳与恶心,对照组(12.20%)与观察组(8.54%)不良反应发生率比较差异无统计学意义(P>0.05)。结论:采用右美托咪定复合异丙酚、瑞芬太尼对面部整形患者进行麻醉可维持患者围术期HR与MAP平稳,降低异丙酚、瑞芬太尼靶质量浓度,镇痛镇静效果显著,且不会增加围术期不良反应,可用于临床推广。

Objective To investigate the application of dexmedetomidine combined with propofol and remifentanil In facial plastic anesthesia.Methods The clinical data of 240 patients who underwent elective plastic surgery in the author's hospital from January to December 2021 were collected retrospectively.The patients were divided into two groups according to different anesthetic modes.Patients in the control group(n=123)were treated with normal saline at 3.6μg/kg/h after entering the room.Patients in the observation group(n=117)were injected with the same volume of dexmedetomidine,and 10 minutes later,the pumping speed was adjusted to 0.3μg/kg/h,with target controlled infusion of propofol and remifentanil during surgery.The two groups were compared in terms of mean arterial pressure(MAP)and heart rate(HR)at 15 minutes before anesthesia(T1),at 2 minutes after intubation(T2),at the beginning of surgery(T3),at 30 minutes after the beginning of surgery(T4)and at tracheal catheter removal(T5),perioperative drug target mass concentration,anesthesia recovery indicators,and adverse reactions.Results There were statistically significant differences in MAP and HR in terms of time effect,inter-group and interaction effect(P<0.05).There was no statistically significant difference between the two groups in MAP and HR at T1,and HR at T4(P>0.05).Compared with the control group,the observation group had lower MAP from T2 to T5,and lower HR at T2,T3 and T5(P<0.05).The target mass concentrations of propofol and remifentanil in the observation group were lower than those in the control group(P<0.05).There was no statistically significant difference in the recovery time of directional force,length of post-anesthesia care unit(PACU)stay,or recovery time of spontaneous respiration between the two groups(P>0.05).The Richmond Agitation Sedation Scale(RASS)score of the observation group at 10 minutes after tracheal catheter removal was lower than that of the control group(P<0.05).The incidence rates of perioperative adverse reactions in the control group and the observation group were 12.20%and 8.54%,without statistically significant difference between groups(P>0.05).Conclusion Applying dexmedetomidine combined with propofol and remifentanil in anesthesia for patients undergoing plastic surgery can maintain stable HR and MAP during the perioperative period,reduce the target mass concentration of propofol and remifentanil,with significant analgesic and sedative effects and without increasing perioperative adverse reactions.