CAJ | 학술논문

目的：比较瑞芬太尼与右美托咪定用于鼻内镜手术控制性降压的临床效果。方法：在全麻下行择期鼻内镜手术的患者40例，随机分为R组、D组，每组20例。两组患者均在鼻腔消毒时开始实施控制性降压，降压目标是维持MAP在60～70 mmHg。R组患者予瑞芬太尼1μg/kg静脉注射（时间＞1 min），0．2～0．4μg/（kg·min）泵注维持；D组患者则予右美托咪定1μg/kg静脉注射（时间＞10 min），0．2～0．7μg/（kg·h）泵注维持。记录麻醉前（T0）、手术开始时（T1）、手术开始30 min（T2）、60 min（T3）、停止降压后10 min（T4）的MAP和HR。记录术中术野质量评分、手术出血量，记录气管拔管时间。患者入PACU时，对其进行Ramsay镇静评分和VRS疼痛评分。结果：两组患者降压期间MAP均能维持在目标范围，术野质量满意。两组患者T1～T3的MAP、HR均较T0时显著降低（P＜0．05）；两组患者在不同时点MAP、HR的比较差异无统计学意义（P＞0．05）。两组患者术野质量评分、手术出血量比较差异无统计学意义（P＞O．05）。 R组气管拔管时间短于D组（P＜0．05）。 R组入PACU时Ramsay评分低于D组（P＜0．05），两组VRS评分比较差异无统计学意义（P＞0．05）。结论：瑞芬太尼与右美托咪定均可安全有效的用于鼻内镜手术控制性降压，术野质量满意，但使用瑞芬太尼术后拔管时间短，清醒更完全，具有快通道麻醉的优势。
목적：비교서분태니여우미탁미정용우비내경수술공제성강압적림상효과。방법：재전마하행택기비내경수술적환자40례，수궤분위R조、D조，매조20례。량조환자균재비강소독시개시실시공제성강압，강압목표시유지MAP재60～70 mmHg。R조환자여서분태니1μg/kg정맥주사（시간＞1 min），0．2～0．4μg/（kg·min）빙주유지；D조환자칙여우미탁미정1μg/kg정맥주사（시간＞10 min），0．2～0．7μg/（kg·h）빙주유지。기록마취전（T0）、수술개시시（T1）、수술개시30 min（T2）、60 min（T3）、정지강압후10 min（T4）적MAP화HR。기록술중술야질량평분、수술출혈량，기록기관발관시간。환자입PACU시，대기진행Ramsay진정평분화VRS동통평분。결과：량조환자강압기간MAP균능유지재목표범위，술야질량만의。량조환자T1～T3적MAP、HR균교T0시현저강저（P＜0．05）；량조환자재불동시점MAP、HR적비교차이무통계학의의（P＞0．05）。량조환자술야질량평분、수술출혈량비교차이무통계학의의（P＞O．05）。 R조기관발관시간단우D조（P＜0．05）。 R조입PACU시Ramsay평분저우D조（P＜0．05），량조VRS평분비교차이무통계학의의（P＞0．05）。결론：서분태니여우미탁미정균가안전유효적용우비내경수술공제성강압，술야질량만의，단사용서분태니술후발관시간단，청성경완전，구유쾌통도마취적우세。
Objective To compare the clinical effect of remifentanil and dexmedetomidine on controlled hypotension during endoscopic sinus surgery. Methods Forty patients undergoing endoscopic sinus surgery were randomly divided into group R and group D, 20 in each group. All patients received controlled hypotension when the surgeons began to sterilize the nasal cavity for the purpose of maintaining the MAP at 60 ~ 70 mmHg. Group R received remifentanil 1μg/kg over 1 minute, followed by 0.2 to 0.4μg/kg per minute infusion during maintenance, whereas group D received dexmedetomidine 1μg/kg over 10 minutes, followed by 0.2 to 0.7μg/kg per hour during maintenance. At the moment of pre-induction(T0), incision(T1), 30 min(T2) and 60 min(T3) after incision and 10 min(T4) after end of controlled hypotension, MAP and HR were measured. Quality of the surgical field, blood loss and extubation time were recorded. Sedation and postoperative pain were assessed on arrival at the PACU. Results The goals for the MAP level were achieved and the surgical field quality was ideal in both groups. The MAP and HR values at T1~ T3 were significantly lower than those at T0 in both groups (P < 0.05). There were no significant differences in the MAP or HR values between the groups at each time point (P>0.05). No significant difference was founded between the groups in the Fromme operative field score and blood loss (P > 0.05). The extubation time was significantly shorter in group R than in group D(P<0.05). The sedation score in the PACU was significantly lower in group R than in group D(P<0.05), while there were no significant differences in postoperative pain between the groups(P<0.05). Conclusion Both remifentanil and dexmedetomidine are safe agents for controlled hypotension and are effective in providing satisfactory surgical fields during endoscopic sinus surgery. However , remifentanil is advantageous in time for extubation and complete consciousness from anesthesia and therefore it may have the advantage of fast track anesthesia.