摘要
目的观察右美托咪定对鼻窦内镜手术后苏醒期躁动的影响。方法选取100例择期行鼻窦内镜手术的患者为研究对象,采用双盲随机法分为D组(右美托咪定组)、C组(对照组)各50例。所有患者在全麻下完成手术。行静脉注射顺苯磺酸阿曲库铵0. 15mg/kg,芬太尼3μg/kg,丙泊酚2mg/kg麻醉诱导,插管成功后行机械通气,维持呼气末CO_2分压(PETCO_2)35～45mmHg,继以丙泊酚4～8mg/(kg·h)和瑞芬太尼0.25μg/(kg·min)持续泵注并间断注射顺苯磺酸阿曲库铵维持麻醉,维持脑电双频指数(BIS)40～60。D组于麻醉诱导时泵注右美托咪定0. 5μg/(kg·h)维持至手术结束;C组输注等量0. 9%氯化钠溶液直至手术结束。分别记录诱导前(T0)、手术后30分钟(T1)、拔管即刻(T2)、拔管后10分钟(T3)、30分钟(T4)两组的心率(HR)和平均动脉压(MAP)、手术时间、出血量、丙泊酚及瑞芬太尼总量、拔管时间,采用Ramsay镇静分级和视觉模拟评分法(VAS)评价两组镇静和疼痛情况;比较两组术后鼻部胀痛、躁动、寒战等不良反应发生率。结果 D组T1、T2、T3、T4时HR、MAP较C组明显降低(P<0.05);与C组比较,D组手术出血量、丙泊酚、瑞芬太尼总量明显减少(P<0. 05);与C组比较,D组VAS疼痛评分明显降低,Ramsay评分明显升高(P<0.05);与C组比较,D组鼻部胀痛、躁动、寒战发生率明显降低(P<0.05)。结论右美托咪定在鼻窦内镜手术中能够有效维持血流动力学稳定,减少丙泊酚及瑞芬太尼的用量,减少苏醒期躁动,提高恢复质量。
Objective To observe the effect of dexmedetomidine on recovery period after endoscopic sinus surgery(ESS).Method 100 patients scheduled for endoscopic sinus surgery were randomly divided into two groups:groupD(dexmedetomidine group)and group C(control group)with 50 patients in each group.All patients were operated under general anesthesia with intravenous injection of cisatracurium 0.15 mg / kg,fentanyl 3μg / kg,propofol 2mg / kg for induction,and then perform mechanical ventilation after intubation.The end expiratory CO2 pressure(PETCO2 )was maintained between 35 ~ 45mmHg.The anesthesia was maintained by continuous infusion of propofol 4 ~ 8mg /(kg·h)and remifentanil 0.25μg /(kg·h)and intermittent injection of cisatracurium and bispectralindex scale(BIS)values were maintained between 40 ~ 60.In group D,dexmedetomidine 0.5μg /(kg·h)was intravenous pumping during anesthesia induction till the end of operation,while in group C,0.9% sodium chloride solution was infused till the end of operation.Before induction(T0),after operation 30 min(T1),immediately after extubation(T2),10 min(T3)and 30 min(T4)after tracheal extubation,the heart rate(HR)and mean arterialpressure(MAP),operation time,blood loss,the total amount of propofol,remifentanil and extubation time were recorded.Ramsay sedation scale and Visual Analongue Scale / Score(VAS)pain scale were used to evaluate the sedation and pain of the two groups,and the incidence of adverse reactions such as nasal distension and pain,restlessnessand shivering were compared between the two groups.Result HR and MAP at T1,T2,T3 and T4 in group D wersignificantly lower than those in group C(P<0.05),blood loss,the requirements of propofol and remifentanyingroup D were significantly lower than those in group C(P<0.05),and VAS pain score in group D was significantlylower than that in group C(P<0.05).Ramsay scores were significantly increased(P<0.05).Compared with groupC,the incidence of nasal Distension and shivering in group D was significantly lower(P<0.05).Conclusion dexmedetomidine in endoscopic sinus surgery can effectively maintain hemodynamic stability,reduce the use of propofoland remifentanil,reduce restlessness during recovery and improve the quality of recovery.
作者
李玉芳
张晓青
赵倩
吴荻
柏满云
LI Yu-Fang;ZHANG Xiao-Qing;ZHAO Qian;WU Di;BO Man-Yun(Fourth Hospital of Changsha,Changsha 410006,China)
出处
《中国临床医生杂志》
2019年第1期24-26,共3页
Chinese Journal For Clinicians
关键词
右美托咪定
鼻窦内镜手术
苏醒期躁动
Dexmedetomidine
Endoscopic sinus surgery
Restlessness during recovery
