不同剂量右美托咪啶对鼻窦手术患者全凭静脉麻醉恢复的影响  

Effects of different doses of dexmedetomidine combined with propofol and remifentanil target controlled infusion on postanesthesia recovery of patients in functional endoscopic sinusessurgery

作　　者：马磊[1] 许静 姚尚龙[3] 张中军[1] 张雪萍[1] 戴中亮[1] 

机构地区：[1]深圳市人民医院麻醉科深圳市麻醉医学工程研究中心,518020 [2]深圳市人民医院病理科 [3]华中科技大学同济医学院附属协和医院麻醉科

出　　处：《中国医师进修杂志》2016年第4期366-370,共5页Chinese Journal of Postgraduates of Medicine

基　　金：广东省自然科学基金（S2013040014054）;深圳市科技研发资金项目（JCYJ20130402092657766）

摘　　要：目的 探讨丙泊酚-瑞芬太尼靶控输注（TCI）辅用不同剂量右美托咪啶对功能性鼻内镜鼻窦手术患者麻醉后恢复的影响.方法 鼻内镜鼻窦手术患者80例,ASA分级Ⅰ或Ⅱ级,按随机数字表法进行分组.对照组（20例）,右美托咪啶处理组（60例）,右美托咪啶处理组均给予负荷量右美托咪啶0.6μg/kg,然后按各亚组不同维持输注剂量开始麻醉,D1组0.3μg/（kg·h）、D2组0.6μg/（kg·h）和D3组0.9μg/（kg·h）,右美托咪啶处理组所有患者均采用丙泊酚-瑞芬太尼TCI静脉全身麻醉,术中间断给予罗库溴铵,麻醉深度维持脑电双频指数（BIS）为40～50.患者入手术室安静5～10 min后（T0）、麻醉诱导前（T1）、气管插管后1 min（T2）、气管插管后5 min（T3）、拔管前（T4）和拔管后5 min（T5）持续监测血流动力学变化,记录术后自主呼吸恢复时间、睁眼时间、拔管时间和术后不良反应发生情况,进行术后疼痛视觉模拟评分（VAS）、Ramsay镇静评分和舒适度评估.结果 T5时对照组、D1组平均动脉压（MAP）均高于D2、D3组（P〈0.05）.T1～T5时D1～D3组心率明显低于对照组（P〈0.05）.D1～D3组呼吸恢复时间、呼之睁眼时间、拔管时间稍微有所延长,但与对照组比较差异无统计学意义（P〉0.05）.D1～D3组拔管后15 min VAS均低于对照组[（3.7±0.3）、（3.1±0.4）、（3.0±0.5）分比（6.2±0.6）分]（P〈0.05）.D1～D3组Ramsay镇静评分均高于对照组[（2.5±0.2）、（2.7±0.2）、（5.3±0.3）分比（1.4±0.3）分]（P〈0.05）,且D3组明显高于D1、D2组,D2组明显高于D1组,差异均有统计学意义（P〈0.05）.术后24 h内对照组、D1组分别有4、2例出现恶心、呕吐.结论 右美托咪啶辅助用于丙泊酚-瑞芬太尼TCI全身麻醉,能维持血流动力学稳定性,显著提高麻醉恢复效果.Objective To investigate the effects of different doses of dexmedetomidine combined with propofol and remifentanil target controlled infusion （TCI） on postanesthesia recovery of patients in functional endoscopic sinus surgery. Methods Eighty ASA Ⅰor Ⅱ grade patients, scheduled for the endoscopic sinus surgery, were divided into control group （20 cases） and dexmedetomidine group （60 cases） according to the random digits table method. The patients in dexmedetomidine group were given loading dose dexmedetomidine 0.6 μg/kg, then were given dexmedetomidine of different maintenance doses：0.3 μg/（kg·h） in D1 group, 0.6 μg/（kg·h） in D2 group and 0.9 μg/（kg·h） in D3 group. The patients in dexmedetomidine group were given TCI propofol and remifentanil during the maintenance of general anesthesia, rocuronium was administrated intermittently during operation, and bispectral index （BIS） was controlled at 40 - 50. The changes of hemodynamics 5 - 10 min after entering operation room （T0）, before induction （T1）, 1 min after intubation （T2）, 5 min after intubation （T3）, before extubation （T4） and 5 min after extubation （T5） were observed. The spontaneous breathing recovery time, call of eye-opening time, extubation time and adverse reaction after surgery were recorded. Moreover, the visual analogue score （VAS） and Ramsay sedation score were used to evaluate the comfort level of patients. Results The mean arterial pressure （MAP） at T5 in control group and D1 group were significantly higher that in D2 group and D3 group, and there were statistical differences （P〈0.05）. The heart rate at T1-T5 in D1-D3 group were significantly lower than that in control group, and there were statistical differences （P〈0.05）. The spontaneous breathing recovery time, call of eye-opening time, extubation time in D1 - D3 group were longer than those in control group, but there were no significant differences （P〉0.05）. The VAS 15 min after extubation in D1 - D3 gro

关 键 词：麻醉 静脉 鼻窦疾病 右美托咪啶 功能性鼻内镜鼻窦手术 

分 类 号：R614[医药卫生—麻醉学]