奥赛利定联合右美托咪定预防性镇痛对鼻内镜泪囊鼻腔吻合术患者的应用研究

Application of oliceridine combined with dexmedetomidine for prophylactic analgesia in patients undergoing endoscopic dacryocystorhinostomy

目的分析奥赛利定(OLI)联合右美托咪定(DEX)对鼻内镜下泪囊鼻腔吻合术(En-DCR)患者的麻醉效果和血流动力学影响。方法招募2024年2月至5月绵阳万江眼科医院行En-DCR患者。根据随机数字表法,将患者随机分为DEX组(仅DEX给药)和联合组(DEX联合OLI给药)。本研究主要观察指标为术后24 h疼痛数字分级评分(NRS)。次要观察指标为心率(HR)、平均动脉压(MAP)、呼吸恢复时间(SRT)、拔管时间(ET)、苏醒时间(AT)、收缩期峰值(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)和血流量(BF)。观察并记录住院期间患者不良反应发生情况。结果研究共纳入患者80例,DEX组和联合组各40例。在镇痛方面,联合组T_(1)(拔出导管后0.5 h内)、T_(2)(术后4 h)、T_(3)(术后8 h)和T_(4)(术后24 h)的NRS均低于DEX组(P<0.05),且联合组补救镇痛率显著低于DEX组(P<0.05)。麻醉效果方面,联合组在T_(6)(麻醉诱导期)、T_(7)(术中)和T_(8)(复苏期间)时间点上的HR和MAP均低于DEX组(P<0.05);与DEX组比较,联合组SRT、ET和AT均较短(P<0.05)。血流动力学方面,术后24 h,两组PSV、EDV和BF较麻醉前明显升高,而RI较麻醉前明显下降(P<0.05);联合组PSV、EDV和BF高于DEX组,RI低于DEX组(P<0.05)。不良反应方面,联合组不良反应发生率显著低于DEX组(P<0.05)。结论OLI联合DEX预防性镇痛对En-DCR患者效果显著,不仅可减轻术后疼痛、稳定血流动力学,缩短拔管及苏醒时间,且减少不良反应发生率。

Objective To analyze the anesthetic effect and hemodynamic impact of oxybutynin(OBI)combined with dexmedetomidine(DEX)on patients undergoing endoscopic dacryocystorhinostomy(En-DCR).Methods Patients who underwent En-DCR from February 2024 to May 2024 at Mianyang Wanjiang Eye Hospital were recruited.They were randomly divided into the DEX group(DEX administration only)and the combined group(DEX combined with OLI administration)according to the random number table method.The primary observational index in this study was the 24-h postoperative pain numerical rating scale(NRS)scores.The secondary observation indexes were heart rate(HR),mean arterial pressure(MAP),respiratory recovery time(SRT),extubation time(ET)and awakening time(AT),peak systolic value(PSV),end-diastolic blood flow velocity(EDV),resistance index(RI)and blood flow(BF).The occurrence of adverse events in patients during hospitalization was observed and recorded.Results A total of 80 patients were included in the study,with 40 in each of the DEX group and the combined group.In terms of analgesia,the NRS scores in the combined group were lower than those in the DEX group at T_(1)(within 0.5 h after catheter removal),T_(2)(4 h postoperatively),T_(3)(8 h postoperatively),and T_(4)(24 h postoperatively)(P<0.05),and the remedial analgesia rate in the combined group was significantly lower than that in the DEX group(P<0.05).Regarding anesthetic effects,HR and MAP at time points T_(6)(during induction of anesthesia),T_(7)(intraoperatively)and T_(8)(during resuscitation)were lower in the combined group than in the DEX group(P<0.05);and SRT,ET and AT were shorter in the combined group compared with the DEX group(P<0.05).In terms of hemodynamics,at 24 h postoperatively,PSV,EDV and BF were significantly higher in both groups compared with those before anesthesia,whereas RI was significantly lower than before anesthesia(P<0.05);PSV,EDV and BF were higher in the combined group than those in the DEX group,and RI was lower than that in the DEX group(P<0.05).Regarding adverse reactions,the incidence of adverse reactions in the combined group was significantly lower than that in the DEX group(P<0.05).Conclusion OLI combined with DEX prophylactic analgesia for patients with En-DCR is effective,not only to reduce postoperative pain,stabilize hemodynamics,shorten the time of extubation and awakening,and reduce the incidence of adverse reactions.