右美托咪啶复合曲马多对鼻窦手术拔管期不良反应的效果  

The effectiveness of low dose dexmedetomidine associated with Tramadol for alleviating adverse effect during extubation after functional endoscopic sinus surgery

作　　者：丁登峰[1] 蔡兴涛[1] 石伟[1] 姜远旭[1] 刁文波[1] 张雪萍[1] 

机构地区：[1]暨南大学第二临床医学院附属深圳市人民医院麻醉科,广东深圳518020

出　　处：《中国内镜杂志》2015年第5期498-501,共4页China Journal of Endoscopy

基　　金：深圳市科技计划项目(No:201203128)

摘　　要：目的观察小剂量右美托咪啶复合曲马多抑制功能性鼻内镜鼻窦手术(FESS)拔管期不良反应的效果。方法拟行FESS患者90例,随机分为A、B、C3组,每组30例,所有患者均采用气管内插管全身麻醉。手术结束前10 min,B组静脉注射右美托咪啶0.3μg/kg,C组静脉注射右美托咪啶0.3μg/kg和曲马多2 mg/kg,A组注射等量生理盐水。记录麻醉前(T0)、拔管即刻(T1)、拔管后5 min(T2)、10 min(T3)的MAP和HR,观察呛咳反应、VAS、Ramsay镇静评分和躁动评分,记录拔管期间高血压、低血压、心动过缓、低氧血症及术后恶心呕吐的发生率。结果 T1~T3时点,A组MAP和HR、B组MAP高于T0时点(P<0.05),B、C组MAP、HR低于A组(P<0.05),C组MAP低于B组(P<0.05);B、C组呛咳反应、VAS、躁动评分低于A组(P<0.05),C组VAS低于B组(P<0.05)。结论 0.3μg/kg右美托咪啶复合2 mg/kg曲马多用于FESS术后拔管,可维持血流动力学稳定,减轻呛咳反应和躁动,提供良好术后镇痛。[ Objective ] To determine the effect of low dose dexmedetomidine associated with tramadol on alleviating adverse effect during extubation after functional endoscopic sinus surgery. [Methods] Ninety patients scheduled to undergo functional endoscopic sinus surgery were randomly assigned to three groups （group A, B, C） with 30 each. All patients received general anesthesia with tracheal intubation. Intravenous 0.3μg/kg dexmedetomidine in group B, 0.3μg/kg dexmedetomidine combined with 2 mg/kg tramadol in group C and the same dose saline in group A were administered in 10 min before the end of surgery respectively. MAP and HR were determined before anesthesia （To）, at the moment of extubation （TI） and 5 min （T2）, 10 min （T3） after extubation. The cough, analgesia, sedation and agitation were assessed by cough grade, visual analogue scale （VAS）, Ramsay sedation scale, agitation grade respectively. The incident of hypertension, hypotension, bradycardia, hyoxemia during extubation and nausea, vomiting after surgery were also recorded. [ Results ] MAP and HR in group A, MAP in group B were higher at T1-T3 than at To （P 〈0.05）. Compared with group A, MAP and HR at Tm-T3, cough grade, VAS and agitation grade werelower in group B, C （P 〈0.05）. MAP and HR at TI^T3 and VAS were lower in group C than in group B （P 〈0.05）. [Conclusion] 0.3 I^g/kg dexmedetomidine associated with 2 mg/kg tramadol during extubation after functional endoscopic sinus surgery can get stable haemodynamics, satisfactory analgesia and mild cough and agitation.

关 键 词：右美托咪啶 曲马多 功能性鼻内镜鼻窦手术 拔管 

分 类 号：R614-24[医药卫生—麻醉学]