右美托咪啶用于局部麻醉下鼻窦开放术的临床观察

目的:评价右美托咪啶用于局部麻醉下鼻窦开放术的可行性及有效性。方法:60例ASAⅠ~Ⅱ级择期进行鼻内镜下鼻窦开放术患者,按随机数字表法分为对照组(S组)及右美托咪啶组(D组),每组30例。D组患者于手术开始前10 min静脉输注右美托咪啶0.5μg/kg,手术开始后以0.4μg/(kg·h)速度持续输注,手术结束前5 min停止给药。S组患者给予注射相同剂量的生理盐水。记录入室时(T0)、手术开始前5 min(T1)、手术开始后5 min(T2)及鼻窦开放时(T3)的MAP、HR;采足背动脉血测定血浆中去甲肾上腺素(NE)及肾上腺素(E)的浓度;并应用视觉模拟评分法(VAS)判断麻醉满意度。结果:与S组相比,D组T1、T2、T3三时间点MAP、HR下降,动脉血中NE及E浓度均降低,差异均有统计学意义(P0.05);麻醉满意度评分明显优于S组,差异有统计学意义(P0.05)。结论:右美托咪啶可有效减轻鼻窦开放时应激反应所导致的血流动力学变化,可安全有效的用于鼻内窥镜手术。

Clinical Observation of Dexmedetomidine Used for Local Anesthesia in Endoscopic Sinus Surgery

Objective：To observe the feasibility and effectiveness of local anesthesia assisted with dexmedetomidine for endoscopic sinus surgery. Method：Sixty patients（ASA I orⅡ）underwent thyroid adenoma surgery were randomly divided into group D and group S according to random number table method,30 patients in each group. In the group D,the patients were intravenously treated with dexmedetomidine,first with loading dose of 0.5μg/kg within 10 minutes before the start of surgery,and then with maintaining dose of 0.4μg/（kg·h）,and was stopped 5 minutes before the end of surgery. The group S was treated with the same dose of saline. MAP,HR were recorded of patients entered the operating room（T0）,5 minutes before the start of surgery（T1）,5 minutes after the start of surgery（T2）and sinus opening hours（T3）;collected arterial blood from the dorsalis pedis artery in 3 mL, detected the levels of norepinephrine（NE）and Epinephrine（E）in arterial blood,and visual analogue score（VAS）judgment satisfaction of anesthesia. Result：Compared with the group S,MAP and HR of the groups D were decreased ,and NE and E concentrations were significantly lower in T1、T2、T3 three time points,the differences were statistically significant（P〈0.05）. VAS score was significantly higher than that of the group S,the differences were statistically significant（P〈0.05）. Conclusion：Dexmedetomidine can effectively reduce the hemodynamic changes when opening the sinuses caused by stress response,and safe and effective for nasal endoscopic surgery.