右美托咪啶用于局麻下隆鼻手术中的临床观察

目的:观察右美托咪啶用于局麻下隆鼻手术的安全性和可行性。方法:40例ASA分级Ⅰ~Ⅱ级择期在局麻行隆鼻手术的患者,随机分为对照组和观察组,每组20例。观察组以右美1μg/kg的负荷量10min泵入后,继之以0.3μg/(kg·h)持续泵注至手术结束前30min;对照组持续泵注等容量的生理盐水。记录两组给药即刻及给药后5、15、30、45min的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SPO2)及Ramesay评分。手术结束时采动脉血测定血浆去甲肾上腺素(NE)和肾上腺素(E)的浓度。结果:结果观察组给药15min后的各时间点HR逐渐下降,但稳定于60次/min左右;在15min时点MAP轻度升高,然后恢复正常;SPO2无明显变化;Ramesay评分逐渐增加,与对照组同时点、同组T0比较(PO.05)。术后NE和E的浓度低于对照组(PO.05)。结论:在局部麻醉下行隆鼻手术中,经静脉泵入右美托咪啶能产生"可唤醒"镇静,呼吸循环稳定,术后应激反应更轻,有利于手术的顺利进行,且安全可靠。

The clinical observation with dexmedetomidine for rhinoplasty surgery under local anesthesia

Objective To evaluate the safety and feasibility of the dexmedetomidine for rhinoplasty surgery under local anesthesia. Methods 40 cases of ASA grade I-II level in patients undergoing elective surgery under local anesthesia line rhinoplasty randomly divided into control group and observation group,20 cases each. After loading the observation group to the dexmedetomidine ling/ kg pumped 10min, followed by 0.3μg/（kg·h） continuous infusion until the end of the surgery 30min; the control group continued infusion volume of saline. Record two administration immediately after administration 5,15,30,45 min and mean arterial pressure （MAP）,heart rate （HR）,pulse oximetry （SPO2） and Ramesay score.Mining arterial plasma norepinephrine （NE） and epinephrine （E） when the concentration of surgical outcome. Results Administration observation group at each time point after 15min HR gradually decreased,but stabilized at 60 beats/min; MAP mildly elevated point in 15min, then returned to normal, Ramesay score gradually increased over the same period compared with the control group （P〈0.05）. Postoperative NE and E concentrations lower than the control group （P〈0.05）. Conclusion Rhinoplasty surgery in local anesthesia by intravenous infusion into the dexmedetomidine can get a good sedative effect,respiratory and circulatory stable postoperative stress response lighter, conducive to the smooth conduct of surgery, and secure.