鼻内镜手术中右美托咪定控制性降压的效果评价*

Effect of Dexmedetomidine on controling hypertension during endoscopic sinus surgery*

摘要:

目的 评价右美托咪定在鼻内镜手术中的降压效果。方法 选取ASAⅠ、Ⅱ级，择期全身麻醉下行鼻内镜手术的患者60例，随机分为右美托咪定组（D组）和生理盐水对照组（C组），每组30例。D组于麻醉诱导前静脉注射右美托咪定1?μg/kg，15?min后以0.4?μg/（kg·h）的速率持续泵入至术毕；C组给予等容量的生理盐水。两组均以丙泊酚、瑞芬太尼持续泵入进行麻醉维持。在纱条填塞鼻腔时停止所有药物。记录麻醉前（T0）、气管插管即时（T1）、控制性降压降至目标血压后30?min（T2）、停药时（T3）、停药后20?min（T4）的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）及眼内压（IOP），并于T0、T4时采集静脉血进行血红蛋白检测，记录两组丙泊酚的用量、苏醒时间及不良反应。由同一手术医生完成手术及术野质量评分。患者入PACU时，对其进行镇静评分。结果 T1～T4时C组的HR高于D组（P?<0.05）；T1时C组的MAP、HR、IOP高于D组（P?<0.05）；T2、T3时两组的MAP均稳定在60～70 mmHg，两组的IOP差异无统计学意义（P?>0.05），T4时C组的MAP、HR、IOP高于D组。D组术野评分、丙泊酚的用量、呼吸恢复时间、术后与术前血红蛋白差值与C组比较，差异有统计学意义（P?<0.05），D组低于C组。两组的拔管时间差异无统计学意义（P?>0.05）；D组入PACU的镇静评分（Ramsay评分）高于C组（P?<0.05）；D组躁动发生率低于C组（P?<0.05）。结论 右美托咪定可安全有效地用于鼻内镜手术控制性降压，术野满意，清醒完全，值得临床推广。

Abstract:

Objective To evaluate the effect of Dexmedetomidine on controlling hypertensive during endoscopic sinus surgery. Methods A total of 60 patients under ASA I/II received general anesthesia for elective endoscopic sinus surgery. Patients were randomly divided into two groups: Dexmedetomidine group (group D) and normal saline control group (group C) (n?=?30). In group D, a loading dose of Dexmedetomidine 1.0?μg/kg was injected intravenously over 15?min before induction, followed by continuous infusion at 0.4?μg/(kg?h) until the end of the operation. While patients in group C received the equal volume of normal saline. The two groups were kept under the continuous infusion of Propofol and remifentanil for standard general anesthesia. SBP, DBP, HR, and IOP at the time of pre-anesthesia (T0), endotracheal intubation (T1), 30?min after controlled hypotension to the target blood pressure (T2), drug withdrawal (T3), and 20?min after drug withdrawal (T4) were recorded. At the time of T0 and T4, venous blood sample was collected for hemoglobin detection. Propofol dosage, recovery time and adverse reaction were recorded in two groups. In PACU, the patient was assessed for a sedative score. Results The heart rate of group C was higher than that of group D at T1-T4 (P?