CAJ | 학술논문

探讨鼻内镜手术时应用右美托咪定对其血流动力学及苏醒期的影响。选择100例行鼻内镜的择期手术患者，随机分为两组，右美托咪定组（D组），持续泵入右美托咪定0．4μg·kg －1·h－1从麻醉诱导开始到拔管结束；对照组（C组），持续泵入相同剂量的生理盐水。诱导药物均为依托咪酯0．3mg／kg ，舒芬太尼0．4μg／kg ，罗库溴铵0．6mg／kg ，术中以丙泊酚6mg · kg －1· h－1、瑞芬太尼0．1μg · kg －1· min－1维持。观察并记录诱导前5min ，手术开始后10min及30min ，手术结束时，拔管时及拔管后2min的MAP及HR；记录术野质量和术中出血量、手术时间和拔管时间、拔管时躁动的发生率、呛咳评分、拔管后患者的Ramsay镇静评分。结果D组在拔管时及拔管后2min血压和心率与C组相比降低（P＜0．05）；D组的术野质量优于C组（P＜0．05），术中出血量D组少于C组（P＜0．05）；两组的手术时间和拔管时间差异无统计学意义；拔管时躁动的发生率及呛咳评分D组低于C组（ P＜0．05）；D组拔管后患者的 Ram say镇静评分高于C组（ P＜0．05）。术中应用右美托咪定，可使鼻内镜手术患者术中血流动力学更稳定，苏醒期更为平稳。
탐토비내경수술시응용우미탁미정대기혈류동역학급소성기적영향。선택100례행비내경적택기수술환자，수궤분위량조，우미탁미정조（D조），지속빙입우미탁미정0．4μg·kg －1·h－1종마취유도개시도발관결속；대조조（C조），지속빙입상동제량적생리염수。유도약물균위의탁미지0．3mg／kg ，서분태니0．4μg／kg ，라고추안0．6mg／kg ，술중이병박분6mg · kg －1· h－1、서분태니0．1μg · kg －1· min－1유지。관찰병기록유도전5min ，수술개시후10min급30min ，수술결속시，발관시급발관후2min적MAP급HR；기록술야질량화술중출혈량、수술시간화발관시간、발관시조동적발생솔、창해평분、발관후환자적Ramsay진정평분。결과D조재발관시급발관후2min혈압화심솔여C조상비강저（P＜0．05）；D조적술야질량우우C조（P＜0．05），술중출혈량D조소우C조（P＜0．05）；량조적수술시간화발관시간차이무통계학의의；발관시조동적발생솔급창해평분D조저우C조（ P＜0．05）；D조발관후환자적 Ram say진정평분고우C조（ P＜0．05）。술중응용우미탁미정，가사비내경수술환자술중혈류동역학경은정，소성기경위평은。
To investigate effect of intraoperative dexmedetomidine infusion on hemodynamic and recovery period after nasal surgery in adult patients. One hundred patients undergoing nasal surgery were randomized into two groups. The dexmedetomidine group (Group D, n= 50) received dexmedetomidine infusion at a rate of 0. 4μg · kg -1 · h-1 from induction of anaesthesia until extubation ,while the control group (Group C ,n= 50) received volume‐matched normal saline infusion as placebo. Etomidate (0. 3mg/kg) ,sufentanil (0. 4μg/kg) and rocuronium (0. 6mg/kg) were used for induction of anaesthesia ,propofol (6mg · kg -1 · h-1 ) and remifentanil (0. 1μg · kg -1 · min-1 ) was used for maintenance of anaesthesia. HR and MAP were recorded before induction of anaesthesia ,10 min after the start of operation ,30 min after the start of operation ,at the end of operation ,at extubation ,and 2 min after extubation. Quality of operation field and intraoperative blood loss, operating time and extubation time, incidence of agitation and scores of cough during extubation ,scores of Ramsay sedation after extubation were recorded. MAP and HR were lower at extubation and 2 min after extubation in Group D than Group C ;Quality of operation field were better in Group D than Group C ;intraoperative blood loss were less in Group D than Group C ;there were no statistical significance in operating time and extubation time between two group;the incidence of agitation and scores of cough were lower in Group D than Group C ;scores of Ramsay sedation after extubation were higher in Group D compared with Group C. Intraoperative infusion of dexmedetomidine provided more stable hemodynamics and recovery period more smoothly.