中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2014年
1期
19-20,21
,共3页
右美托咪啶%鼻内窥镜手术%应激
右美託咪啶%鼻內窺鏡手術%應激
우미탁미정%비내규경수술%응격
Dexmedetomidine%Nasal endoscopy surgery%Stress response
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（P<0.05）；麻醉满意度评分明显优于S组，差异有统计学意义（P<0.05）。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。
目的：評價右美託咪啶用于跼部痳醉下鼻竇開放術的可行性及有效性。方法：60例ASAⅠ~Ⅱ級擇期進行鼻內鏡下鼻竇開放術患者，按隨機數字錶法分為對照組（S組）及右美託咪啶組（D組），每組30例。D組患者于手術開始前10 min靜脈輸註右美託咪啶0.5μg/kg，手術開始後以0.4μg/（kg·h）速度持續輸註，手術結束前5 min停止給藥。S組患者給予註射相同劑量的生理鹽水。記錄入室時（T0）、手術開始前5 min（T1）、手術開始後5 min（T2）及鼻竇開放時（T3）的MAP、HR；採足揹動脈血測定血漿中去甲腎上腺素（NE）及腎上腺素（E）的濃度；併應用視覺模擬評分法（VAS）判斷痳醉滿意度。結果：與S組相比，D組T1、T2、T3三時間點MAP、HR下降，動脈血中NE及E濃度均降低，差異均有統計學意義（P<0.05）；痳醉滿意度評分明顯優于S組，差異有統計學意義（P<0.05）。結論：右美託咪啶可有效減輕鼻竇開放時應激反應所導緻的血流動力學變化，可安全有效的用于鼻內窺鏡手術。
목적：평개우미탁미정용우국부마취하비두개방술적가행성급유효성。방법：60례ASAⅠ~Ⅱ급택기진행비내경하비두개방술환자，안수궤수자표법분위대조조（S조）급우미탁미정조（D조），매조30례。D조환자우수술개시전10 min정맥수주우미탁미정0.5μg/kg，수술개시후이0.4μg/（kg·h）속도지속수주，수술결속전5 min정지급약。S조환자급여주사상동제량적생리염수。기록입실시（T0）、수술개시전5 min（T1）、수술개시후5 min（T2）급비두개방시（T3）적MAP、HR；채족배동맥혈측정혈장중거갑신상선소（NE）급신상선소（E）적농도；병응용시각모의평분법（VAS）판단마취만의도。결과：여S조상비，D조T1、T2、T3삼시간점MAP、HR하강，동맥혈중NE급E농도균강저，차이균유통계학의의（P<0.05）；마취만의도평분명현우우S조，차이유통계학의의（P<0.05）。결론：우미탁미정가유효감경비두개방시응격반응소도치적혈류동역학변화，가안전유효적용우비내규경수술。
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.
