右美托咪定术前滴鼻辅助用于局麻下斜视矫正术患者的临床效果  

The clinical effect of dexmedetomidine preoperative nasal drip assisted in patients with strabismus correction under local anesthesia

作　　者：巫绍汝 彭科[1] 陈庆才[1] WU Shao-ru;PENG Ke;CHEN Qing-cai(Department of Anesthesiology,First Affiliated Hospital of Soochow University,Soochow 215006,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院麻醉科,苏州215006

出　　处：《医学研究生学报》2020年第8期826-829,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81601659)。

摘　　要：目的充分镇静镇痛且不影响患者配合手术操作指令是斜视矫正手术麻醉成功的关键。文中旨在探讨术前右美托咪定滴鼻辅助用于斜视矫正手术患者,对镇静焦虑评分、循环指标、药物用量(阿托品、舒芬太尼)以及不良反应等指标的影响。方法选择2017年3月至2018年10月苏州大学附属第一医院眼科90例局麻下行斜视矫正术患者。采用随机数字表法分为(n=45):右美托咪定组(经鼻滴入右美托咪定2μg/kg)、对照组(经鼻滴入等量等渗盐水)。记录给药前、给药后10 min、给药后20 min、给药后30 min的平均动脉压、心率,并在术前1天、术后1天行焦虑自评量表(SAS),给药后30 min行Ramsay评分,统计术中阿托品、舒芬太尼用量以及不良反应的发生情况。结果右美托咪定组患者在给药后20 min的心率[(72.7±9.1)次/min]、平均动脉压[(83.1±10.6)mmHg]较给药前[(78.3±11.4)次/min、(89.4±10.0)mmHg]明显下降,给药后30 min较给药前亦下降(P<0.05),且明显低于对照组(P<0.05)。右美托咪定组患者给药后30 min的Ramsay镇静评分显著高于对照组(P<0.05)。2组患者术后1天的SAS评分均较术前1天降低(P<0.05),且术后1 d,右美托咪定组SAS评分较对照组明显降低(P<0.05)。右美托咪定组舒芬太尼用量明显低于对照组(P<0.05)。右美托咪定组恶心呕吐的发生率明显低于对照组(7%vs 22%,P<0.05)。结论右美托咪定(2μg/kg)术前滴鼻具有良好的镇静作用,无明显的不良反应,可安全辅助用于局麻下斜视矫正手术患者的临床麻醉。Objective To evaluate the effects of intranasal dexmedetomidine premedication on Sedation anxiety score,circulation index,drug dosage(atropine,sufentanil),and adverse reactions in patients undergoing strabismus surgery with local anesthesia.Methods Ninety patients undergoing strabismus surgery were enrolled and randomly divided into the dexmedetomidine group(n=45)and control group(n=45).30min before the local anesthesia,dexmedetomidine was given intranasally with a dose of 2μg/kg in the dexmedetomidine group,while the control group treated equal volume saline.The MAP and HR values before pre-dose(T0),10 min(T1),20 min(T2),and 30 min(T3)were recorded.The Ramsay score was calculated 30 minutes after administration.SAS scores were made 1 day before surgery and 1 day after surgery.Meanwhile,we measured the dosage of atropine,sufentanil,and the incidence of adverse reactions during surgery.Results The HR and MAP of patients in the dexmedetomidine group were significantly lower than those in the control group at T2 and T3(P<0.05).The SAS score of the dexmedetomidine group was significantly lower than that of the control group 1 day after the operation.There was no significant difference between the dexmedetomidine group and the control group in the dosage of atropine,the incidence of oculocardiac reflex(OCR),and respiratory depression.The dose of sufentanil in the dexmedetomidine group was lower than that of the control group.The incidence of nausea and vomiting in the control group was significantly higher than that of the dexmedetomidine group.Conclusion Dexmedetomidine(2μg/kg)preoperative nasal drip has a good sedative effect without obvious adverse reactions and could be safely assisted in clinical anesthesia for patients undergoing local anesthesia correction surgery.

关 键 词：右美托咪定 滴鼻 斜视矫正术 镇静 

分 类 号：R779.6[医药卫生—眼科]