摘要
目的观察应用右美托咪定复合丙泊酚瑞芬太尼对鼻内镜手术患者应激反应的影响。方法选择年龄18~55岁,择期行鼻内镜手术患者60例,采用随机数字法随机分为右美托咪定组(D组)和0.9%氯化钠溶液组(C组),每组30例。D组于麻醉诱导前静脉注射右美托咪定负荷剂量1μg/kg,15 min后以0.4μg·kg-1·h-1的速率持续泵至术毕,C组给予等容量的0.9%氯化钠溶液。2组患者麻醉诱导气管插管后均以丙泊酚、瑞芬太尼持续泵入进行麻醉维持,使BIS值维持在40~60,在手术结束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),手术开始后30 min(T2),停药时(T3)、停药后20 min(T4)的MAP、HR、IOP,并于T0、T2、T4时刻采集动脉血进行血气分析,并采集静脉血进行血糖(BG),皮质醇(Cor)测定。结果2组T1~T4时刻心率差异有统计学意义(P<0.05),T1~T4时刻C组的心率均高于D组(P<0.05);T1、T4时刻C组的MAP、HR、IOP均高于D组(P<0.05);C组T2和T4时点的血糖和皮质醇水平较D组明显升高(P<0.05)。结论右美托咪定能有效抑制应激反应,有利于患者手术安全,适用于鼻内镜手术的麻醉。
Objective To investigate the Effects of dexmedetomidine combined with propofol and remifentanil on stress response in patients undergoing nasal endoscopic surgery(NES).Methods A total of 60 patients with age range being 18~55yr who were scheduled for endoscopic sinus surgery were randomly divided into dexmedetomidine group(group D,n=30)and 0.9%sodium chloride solution group(group C,n=30).The patients in group D were intravenously injected with dexmedetomidine of 1μg/kg load dosage before anesthesia induction,and after 15 minutes the patients were pump intravenously at a rate of 0.4μg·kg-1·h-1 until the end of operation.However the patients in group C were given the equal volume of 0.9%sodium chloride solution.The patients in both groups were anesthetized by continuous pump infusion of propofol and remifentanil after anesthesia induction,which kept the BIS value maintaining in the range of 40~60.All the drugs were stopped until the end of operation when the gauze was filled into the nasal cavity.The MAP,HR,IOP before anesthesia(T0),at the time of trachea cannula(T1),30min after the operation beginning(T2),the time of drug withdrawal(T3),20min after the drug withdrawal(T4)were recorded.Moreover the arterial blood specimens at T0,T2,T4 were collected for blood gas analysis,and the venous blood specimens were collected to detect the levels of blood glucose(BG)and cortisol(Cor).Results There was significant difference in heart rate during T1~T4 between the two groups(P<0.05).The heart rates of patients in group C during T1~T4 were significantly higher than those in group D(P<0.05).Moreover the MAP,HR,and IOP during T1~T4 in group C were significantly higher than those in group D at T1 and T4(P<0.05).In addition the levels of BG and Cor in group C during T2~T4 were significantly higher than those in group D(P<0.05).Conclusion The dexmedetomidine can effectively inhibit stress response of patients,which is beneficial for the safety of patients and is suitable for anesthesia in nasal endoscopic surgery.
作者
张云鹏
纪国余
董天鑫
董龙
王志学
李艳
ZHANG Yunpeng;JI Guoyu;DONG Tianxin(Department of Anesthesiology,Nanyuan District,Affiliated Hospital of Chengde Medical College,Hebei,Chengde 067000,China;不详)
出处
《河北医药》
CAS
2020年第6期868-871,共4页
Hebei Medical Journal
基金
承德市科学技术研究与发展支撑计划项目(编号:201701A090)。
关键词
右美托咪定
鼻内镜手术
应激反应
麻醉
dexmedetomidine
nasal endoscopic surgery
stress reaction
anesthesia
