右美托咪啶用于OSAHS患者鼻内窥镜手术的临床观察  

Clinical observation of dexmedetomidine in nasal endoscope operation for OSAHS patients

作　　者：刘纪泽[1] 杨光[1] 曾宪阳[1] 李桂芹[2] 刁玉刚[2] 

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

出　　处：《辽宁医学杂志》2014年第6期304-307,共4页Medical Journal of Liaoning

摘　　要：目的观察右美托咪啶（DEX）用于阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者鼻内窥镜手术全身麻醉的优越性。方法择期OSAHS鼻内窥镜手术患者60例,随机双盲分为两组：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1.0μg/kg,15分钟输完,维持输注0.2～0.7μg/（kg·h）至术毕。C组麻醉诱导以同样方式输注生理盐水,维持输注瑞芬太尼0.1～0.2μg/（kg·min）至术毕。分别记录两组患者在麻醉诱导前（T0）,静脉注入芬太尼前（T1）、气管插管时（T2）、手术20分钟时（T3）、拔管时（T4）以及拔管后10分钟（T5）的收缩压（SBP）、舒张压（DBP）、心率（HR）、动脉氧饱和度（SpO2）和麻醉深度指数（CSI）,以及T2和T4呛咳评分、T4躁动评分、T5镇静评分、镇痛评分和合作评分。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）,但在T5时SpO2较C组同时间点高（P〈0.05）。D组T2和T4呛咳评分、T4躁动评分、T5镇痛评分较C组同期其值低（P〈0.05）。T5镇静评分和合作评分较C组同期值高（P〈0.05）。结论DEX用于OSAHS鼻内窥镜手术麻醉,患者麻醉诱导呛咳少,术中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 with OSAHS undergoing en- doscopic sinus surgery under general anesthesia. Methods The selective endoscopic sinus surgery 60 patients with OSAHS randomly divided into 2 groups （n = 30, each） ：experiment group （D group） and contrast group （C group）. In D group, the patients received intravenous injection of DEX （ 1 μg/kg ） in 15 minutes before intubation, and then received injection of DEX at a rate of 0. 2 -0. 7 μg/ （kg-h） before the operation finishing. While in C group,physiological saline was used in- stead of DEX, and then received injection of remifentanil at a rate of 0. 1 - 0. 2μg/（ kg. m） before the operation finishing. SBP, DBP, HR, SpO2 and CSI were determined before anesthesia （ To ）, before intravenous injection of fentanyl （ TI ）, during intubation （ T2 ）, 20 minutes after operation （ T3 ）, during extubation （ T4 ）, 10 minutes after extubation （ T5 ）. Oberved and recorded ： Cough score of T2 and T4 , Agitation scale of T4 ; sedation score, visual analogue scale and cooperative score of T5. Re- sults Compared at the same time points. Lots of SBP, DBP, HR of D group were significantly lower than those in C group at T（2-5） （P 〈 0. 05 ）, But SpO2 of D group were significantly higher than those in C group at T5. Cough score of T2 , Cough score T4, Agitation scale of T4 and visual analogue scale of T5 of D group were significantly lower than those in C group（ P 〈 0. 05 ）. sedation score and cooperative score of T5 of D group were significantly higher than those in C group（ P 〈0. 05 ）. Conclusion The patients with OSAHS used with DEX during endoscopic sinus surgery, can deduce 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,have no significant respirati

关 键 词：右美托咪啶 阻塞性睡眠呼吸暂停低通气综合征 鼻内窥镜手术 血流动力学 

分 类 号：R614[医药卫生—麻醉学]