右美托咪定用于鼻内窥镜手术患者的临床研究  

Clinical observation of dexmedetomidine in the patients undergoing endoscopic sinus surgery

作　　者：刘纪泽[1] 杨光[1] 曾宪阳[1] 李桂芹[2] 

机构地区：[1]武警辽宁省总队医院麻醉科,沈阳110034 [2]沈阳军区总医院麻醉科,沈阳110016

出　　处：《实用药物与临床》2013年第3期198-200,共3页Practical Pharmacy and Clinical Remedies

摘　　要：目的观察右美托咪定(Dexmedetomidine,DEX)用于鼻内窥镜手术全身麻醉的优越性。方法择期行鼻内窥镜手术患者60例,随机双盲分为2组:实验组(D组)和对照组(C组),每组30例。D组于麻醉诱导输注DEX负荷剂量1μg/kg,15 min输完,麻醉维持持续输注0.2～0.7μg/(kg.h)至术毕前15 min;C组麻醉诱导以同样方式输注生理盐水,麻醉维持输注丙泊酚2～3 mg/(kg.h)至术毕前5 min。分别记录两组患者在麻醉诱导前(T0)、静脉注入芬太尼时(T1)、气管插管时(T2)、手术20 min时(T3)、拔管时(T4)以及拔管后10 min(T5)的血压(SBP、DBP)、心率(HR)、脉搏氧饱和度(SpO2)、麻醉深度指数(CSI),以及T1、T2和T4呛咳评分、T4躁动评分、T5镇静评分和镇痛评分。结果 D组在T2～T5多时间点的SBP、DBP、HR较C组同期值低(P<0.05),但其T5SpO2高于C组(P<0.05)。D组T1、T2和T4呛咳评分、T4躁动评分、T5镇静评分和镇痛评分较C组同期值低(P<0.05)。结论 DEX用于鼻内窥镜手术麻醉,使患者麻醉诱导呛咳少,术中患者血流动力学相对稳定,术后苏醒完全,呛咳躁动发生率低,有良好的镇静镇痛作用,而无明显呼吸抑制。Objective To observe the advantage of dexmedetomidine（DEX） in the patients undergoing endoscopic sinus surgery. Methods The 60 patients of selective endoscopic sinus surgery were randomly divided into 2 groups：experiment group（D group）and control group（ C group） ,30 cases in each group. In D group, the patients received intravenous injection of DEX （ 1 μg/kg） 15 min before intubation, and then received continuous injection of DEX at a rate of 0. 2 -0. 7μg /（ kg· h）till 15 rain before the operation finishing. In C group, physiological saline was used instead of DEX, and the injection of propofol was given at a rate of 2 - 3 mg/（kg·h） till 5 min continuously before the operation finishing. Systolic blood pressure （SBP） , diastole blood pressure （DBP） , heart rate （HR） , pulse oxygen saturation （ SpO2 ） and cerebral state index （CSI） were determined before anesthesia （ T0 ） , at intravenous injection of fentanyl （ T1 ） , during intubation （ T2 ） , 20 min after operation （ T3 ） , during extubation （ Y4 ） , 10 rain after extubation （ T5 ）. The following indexes were observed and recorded：Cough score at T1 ,T2 and T4 ;Agitation scale at T4 ;sedation score and visual analogue scale at T5. Results SBP, DBP, HR of D group at T2 - T5 were significantly lower than that in C group at the same time points（ P 〈 0. 05 ） ,but SpO2 of D group were significantly higher than that in C group at T5. Cough score at T1, T2 and T4, agitation scale at T4 , sedation score and visual analogue scale at T5 of D group were significantly lower than those in C group at the same time points （ P 〈 0. 05 ）. Conclusion The patients using DEX during endoscopic sinus surgery can reduce cough during induce of anesthesia, keep haemodynamics of stability in operation, regain consciousness completely at post-anesthesia, decrease cough and agitation at extubation, maintain better sedation score and visual analogue scale at post-operation without significant respiration

关 键 词：右美托咪定 鼻内窥镜手术 血流动力学 并发症 

分 类 号：R614[医药卫生—麻醉学]