经鼻蝶入路垂体瘤切除术全麻恢复期应激的防治:右美托咪定联合复方利多卡因乳膏的效果  

Prevention and treatment of stress during recovery from general anesthesia in transnasal transphenoidal pituitary adenoma resection:efficacy of dexmedetomidine combined with compound lidocaine cream

作　　者：李轶[1] 许琳涓[1] 陈开平 杨小华[1] Li Yi;Xu Linjuan;Chen Kaiping;Yang Xiaohua(Department of Anesthesiology,Lanzhou University Second Hospital,Lanzhou 730030,China;Department of Outpatient,Beijing Weixu District Chaoyang Seventh Retired Cadres Sanatorium,Beijing 100025,China)

机构地区：[1]兰州大学第二医院麻醉科,730030 [2]北京卫戌区朝阳第七退休干部休养所门诊部,100025

出　　处：《中华麻醉学杂志》2021年第12期1437-1440,共4页Chinese Journal of Anesthesiology

基　　金：甘肃省自然科学基金(18JR3RA318)。

摘　　要：目的评价右美托咪定联合复方利多卡因乳膏对经鼻蝶入路垂体瘤切除术患者全麻恢复期应激反应的防治效果。方法择期全麻下行经鼻蝶入路垂体瘤切除术患者90例,年龄18~64岁,BMI 18~25 kg/m^(2),ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为3组(n=30):右美托咪定联合复方利多卡因乳膏组(D-L组)、右美托咪定组(D组)和复方利多卡因乳膏组(L组)。D-L组和L组于气管导管前1/3和套囊表面均匀涂抹复方利多卡因乳膏2 g,D组涂抹石蜡油;D-L组和D组于手术结束前30 min静脉泵注右美托咪定0.5μg/kg,给药时间10 min,L组泵注等容量生理盐水。监测围气管拔管期HR和MAP,记录气管拔管反应发生情况;于入室后(t_(0))、麻醉诱导后(t_(1))和气管拔管后5 min(t_(2))时超声测量视神经鞘直径(ONSD);记录麻醉恢复期呛咳和躁动评分。结果与D组和L组比较,D-L组呛咳及气管拔管反应的发生率降低(分别为27%、37%、6%;23%、27%、3%,P<0.05);与L组比较,D-L组和D组躁动发生率降低(分别为37%、10%、13%,P<0.05);D-L组未见重度呛咳及躁动发生。各组患者不同时点ONSD比较差异无统计学意义(P>0.05)。结论右美托咪定联合复方利多卡因乳膏,不仅明显优于单独应用的效果,还可防治经鼻蝶入路垂体瘤切除术患者全麻恢复期的应激反应。Objective To evaluate the efficacy of combination of dexmedetomidine and compound lidocaine cream for the prevention and treatment of the stress responses during recovery from general anesthesia in the patients undergoing transnasal transphenoidal pituitary adenoma resection.Methods A total of 90 patients,aged 18-64 yr,with body mass index of 18-25 kg/m^(2),of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective pituitary tumor resection by transsphenoidal approach with general anesthesia,were divided into 3 groups(n=30 each)by the random number table method:combination of dexmedetomidine and compound lidocaine cream group(D-L group),dexmedetomidine group(D group)and compound lidocaine cream group(L group).Compound lidocaine cream 2 g was applied to the anterior 1/3 of the tracheal tube and surface of the cuff in D-L and L groups,and paraffin oil was applied to the surface of the tracheal tube in group D.In D-L and D groups,dexmedetomidine 0.5μg/kg was intravenously infused for 10 min at 30 min before the end of surgery,while the equal volume of normal saline was given in group L.Heart rate and mean arterial pressure were continuously monitored during peritracheal extubation,and the occurrence of responses to extubation was recorded.The optic nerve sheath diameter(ONSD)was measured by ultrasound after entering the operating room(t_(0)),after anesthesia induction(t_(1)),and at 5 min after extubation(t_(2)).The bucking and agitation scores were recorded during recovery from anesthesia.Results Compared with group D and group L,the incidence of bucking and responses to extubation was significantly decreased in group D-L(27%,37%,6%;23%,27%,3%,respectively,P<0.05).Compared with group L,the incidence of agitation was significantly decreased in D-L and D groups(37%,10%,13%,respectively,P<0.05).No severe bucking and agitation occurred in group D-L.There was no significant difference in ONSD at each time point among three groups(P>0.05).Conclusion Combination of dexmedetomidine and compound

关 键 词：右美托咪啶 利多卡因 膏剂 垂体肿瘤 应激 手术后并发症 

分 类 号：R614[医药卫生—麻醉学] R736.4[医药卫生—外科学]