右美托咪定复合七氟醚控制性降压在鼻内窥镜手术中的应用  

Application of Dexmedetomidine Combined Sevoflurane in Deliberate Hypotension for Nasal Endoscopic Surgery

作　　者：陈本军[1] 黄昌林[1] 孟哲贤[1] 

机构地区：[1]湖南省常德市第一人民医院麻醉科,湖南常德415003

出　　处：《医学临床研究》2011年第6期1157-1159,共3页Journal of Clinical Research

摘　　要：【目的】观察右美托咪定复合七氟醚控制性降压用于鼻内窥镜手术的有效性和安全性。【方法】鼻内窥镜手术患者40例，ASAI～Ⅱ级，随机分成两组。I组（20例）采用右美托咪定复合七氟醚控制性降压，Ⅱ组（20例）采用七氟醚麻醉。两组病人麻醉诱导均采用咪达唑仑，顺式苯磺酸阿曲库铵，芬太尼，依托咪酯。手术开始后I组吸入1％～2％七氟醚，用微量泵泵入右美托咪定，使平均动脉压（MAP）控制在65mmHg左右并维持，Ⅱ组吸入1％～3％七氟醚，维持血压在术前基础水平，两组均用微量泵泵入丙泊酚，间断静注芬太尼和顺式苯磺酸阿曲库铵维持麻醉。观察术中出血量，手术时间以及麻醉前（T1），手术开始后10min（T2）、手术开始后60min（Ts）、手术结束拔管后即刻（T4）的MAP、心率（HR）的变化。【结果】I组患者术中出血量、手术时间较Ⅱ组显著减少（P〈0．05）；I组患者术中MAP、HR明显低于术前（P〈0．05）。【结论】右美托咪定复合七氟醚控制性降压用于鼻内窥镜手术能有效减少出血量，改善手术野，缩短手术时间。[Objective]To observe the availability and safety of dexmedetomidine combined sevoflurane in deliberate hypotension for nasal endoscopic surgery. [Methods] Forty ASA I-Ⅱ patients undergoing nasal endoscopic surgery were randomly divided into two groups. Group I （ n = 20） was given dexmedetomidine combined sevoflurane for deliberate hypotension and group Ⅱ（ n = 20） was anesthetized with sevoflurane. Midazolam, cisatracurium besylate, fentanyl and etomidate were used for the anesthesia induction of two groups. After the start of surgery, in group Ⅰ 1%-2% sevoflurane was inhaled and dexmedetomidine was infused into micro pump to maintain mean arterial pressure（MAP） around 65mmHg. In group Ⅰ, 1% -3% sevoflurane was inhaled and blood pressure was maintained at the base level before operation. In two groups, propofol was infused into micro pump, and fentanyl and cisatracurium besylate were intravenously injected at interval to maintain the anesthesia. Blood loss, operation time, MAP and heart rate（HR） before anesthesia（T1）, 10min after operation（Tz）, 60min after operation （Ta） and the immediate after extubation（T4） were observed. [Resuits] Blood loss and operation time in group I were significantly less than those in group Ⅰ （ P〈0.05）. The MAP and HR in group I during operation were significantly lower than those before operation（ P〈0.05）.. [Conclusion] Dexmedetomidine combined with sevoflurane in deliberate hypotension for nasal endoscopic surgery can effectively reduce blood loss, improve the operating field and shorten the operation time.

关 键 词：催眠药和镇静药/投药和剂量 醚类/投药和剂量 外科手术 内窥镜 耳鼻咽喉科学 

分 类 号：R76[医药卫生—耳鼻咽喉科]