右美托咪定与尼卡地平用于正颌手术患者控制性降压的对比研究

目的：对比右美托咪定与尼卡地平用于正颌手术控制性降压的效果。方法：正颌患者60例，随机分为右美托咪定组（D 组）和尼卡地平组（N 组）。控制性降压：D 组以1μg／kg 剂量泵注右美托咪定，10 min 后以0．2～0．7μg／（kg·h）维持；N组泵注尼卡地平0．75μg／（kg·min）至目标血压后以0．2～0．5μg／（kg·min）维持。记录诱导前（T0）、降压即刻（T1）、降压后10 min（T2）、20 min（T3）、30 min（T4）、60 min（T5）、停止降压后10 min（T6）、30 min（T7）、术毕（T8）HR、MAP 变化；记录阿片类药物用量、拔管前 Riker 评分、拔管后5 min Ramsay 评分。结果：2组 T2～T7时 MAP 与 T0比较明显下降（P ＜0．05）；与 N 组比较，D 组拔管后5 min Ramsay 评分明显增加（P ＜0．05），瑞芬太尼用量、拔管前 Riker 评分明显下降（P ＜0．05）。结论：与尼卡地平比较，右美托咪定行控制性降压术中血流动力学平稳、阿片类药物用量减少以及术后躁动发生率降低。

A comparative study of dexmedetomidine and nicardipine in the induction of controlled hypotension in the patients during orthognathic surgery

Objective:To compare the effects of dexmedetomidine and nicardipine in the induction of controlled hypotension in the pa-tients during orthognathic surgery.Methods:60 patients were randomly divided into 2 groups(n =30).The patients in group D were intravenously pumped with 1 μg/kg dexmedetomidine for 10 min followed by 0.2 ~0.7 μg/(kg·h).Those in group N were pumped with nicardipine for an initial dose of 0.75 μg/(kg·min)followed by 0.2 ~0.5 μg/(kg·min).HR,MAP were recorded before in-duction (T0 ),start of hypotension(T1 ),10 min(T2 ),20 min (T3 ),30 min(T4 )and 60 min(T5 )after hypotension,10 min(T6 ), 30 min(T7 )after stop of hypotension,and at the end of surgery(T8 ).The remifentanil dosage was recorded.Riker sedation-agitation score (RSAS)before extubation and Ramsay score 5 min after extubation were observed.Results:Comparing with T0 ,MAP at T2 -T7 in the 2 groups were significantly decreased(P <0.05).The intraoperative remifentanil consumption in group D was significantly lower than that in group N (P <0.05).The Ramsay score in group D was significantly higher than that in group N(P <0.05).The RSAS in group D was significantly lower than that in group N(P <0.05).Conclusion:Both dexmedetomidine and nicardipine are safe for con-trolled hypotension in providing ideal surgical field during orthognathic surgery.Dexmedetomidine can produce more stable hemdynamic indexes and offer more advantage in postoperative sedation.