CAJ | 학술논문

目的：：研究右美托咪定在经鼻微创垂体瘤切除手术的临床应用,评价其有效性、安全性及实用性。方法：将择期全麻经鼻微创垂体瘤切除术患者40例,随机均分成D组与C组。 D组为右美托咪定组,麻醉诱导前10 min微量注射泵静脉输注负荷剂量1μg·kg-1·10 min-1,10 min后以0.4μg·kg-1·h-1泵速维持；C组为对照组,按照相同的方式输注0.9%氯化钠注射液。所有患者应用硝酸甘油,将平均动脉压维持于60~70 mmHg；微量注射泵静脉输注丙泊酚,并在脑电双频指数监测下,调整泵注速度,维持脑电双频指数40~50。观察患者不同时刻血压、心率的变化,记录术中Fromme术野质量评分、手术时间与出血量、丙泊酚及硝酸甘油平均用药量,记录术后患者自主呼吸恢复时间、苏醒时间、清醒拔管时间,拔管时、拔管后1h及2 h的Ramsay镇静评分以及拔管后2 h内寒战、过度镇静的发生情况。结果：与C组比较,D组出血量少、Fromme术野质量评分较低、手术时间缩短(P<0.05~P<0.01),且控制性降压期间的心率较低(P<0.01),气管插管、拔管时平均动脉压及心率波动小,血流动力学较平稳(P<0.01)；D组较C组的丙泊酚及硝酸甘油的平均用药量均显著降低(P<0.01)；2组术后苏醒时间及拔管时间差异均无统计学意义(P>0.05)；D组患者在拔管时刻的Ramsay镇静评分高于C组(P<0.01),拔管后1 h的Ramsay镇静评分低于C组(P<0.05),拔管后2 h,2组的Ramsay镇静评分差异无统计学意义(P>0.05)；拔管后2 h内,D组患者的寒战发生率低于C组(P<0.05)。结论：右美托咪定联合硝酸甘油用于经鼻微创垂体瘤切除术,能显著改善术野评分,缩短手术时间；同时可有效维持血流动力学稳定,术后镇静效果好且无过度镇静现象,具有临床有效性、实用性与安全性。
목적：：연구우미탁미정재경비미창수체류절제수술적림상응용,평개기유효성、안전성급실용성。방법：장택기전마경비미창수체류절제술환자40례,수궤균분성D조여C조。 D조위우미탁미정조,마취유도전10 min미량주사빙정맥수주부하제량1μg·kg-1·10 min-1,10 min후이0.4μg·kg-1·h-1빙속유지；C조위대조조,안조상동적방식수주0.9%록화납주사액。소유환자응용초산감유,장평균동맥압유지우60~70 mmHg；미량주사빙정맥수주병박분,병재뇌전쌍빈지수감측하,조정빙주속도,유지뇌전쌍빈지수40~50。관찰환자불동시각혈압、심솔적변화,기록술중Fromme술야질량평분、수술시간여출혈량、병박분급초산감유평균용약량,기록술후환자자주호흡회복시간、소성시간、청성발관시간,발관시、발관후1h급2 h적Ramsay진정평분이급발관후2 h내한전、과도진정적발생정황。결과：여C조비교,D조출혈량소、Fromme술야질량평분교저、수술시간축단(P<0.05~P<0.01),차공제성강압기간적심솔교저(P<0.01),기관삽관、발관시평균동맥압급심솔파동소,혈류동역학교평은(P<0.01)；D조교C조적병박분급초산감유적평균용약량균현저강저(P<0.01)；2조술후소성시간급발관시간차이균무통계학의의(P>0.05)；D조환자재발관시각적Ramsay진정평분고우C조(P<0.01),발관후1 h적Ramsay진정평분저우C조(P<0.05),발관후2 h,2조적Ramsay진정평분차이무통계학의의(P>0.05)；발관후2 h내,D조환자적한전발생솔저우C조(P<0.05)。결론：우미탁미정연합초산감유용우경비미창수체류절제술,능현저개선술야평분,축단수술시간；동시가유효유지혈류동역학은정,술후진정효과호차무과도진정현상,구유림상유효성、실용성여안전성。
Objective:To explore the clinical application of dexmedetomidine combined with nitroglycerin in minimally invasive resection of pituitary adenoma through nose,and assess its effectiveness,safety and practicality. Methods:Forty patients scheduled by minimally invasive resection of pituitary adenoma through nose were randomly divided into the D group and C group. The D group ( dexmedetomidine group) were intravenously injected with a loading lose of dexmedetomidine(1μg·kg-1 ·10 min-1 ) 10 min before anesthesia induction by micro-injection pump,following by a continuous infusion at a rate of 0. 4μg·kg-1 ·h-1 ,and the C group were injected with 0. 9% sodium chloride injection in the same way. The mean arterial pressure of all patients were maintained for between 60 and 70 mmHg using nitroglycerin,and the propofol infusion speed was adjusted according to the bispectral index in order to maintain the bispectral index for between 40 to 50. The blood pressure and heart rate in all patients were observed,the intraoperative Fromme operative field quality score,operation time,blood loss,and average dose of propofol and nitroglycerin of all patients were recorded. The time of postoperative spontaneous breathing recovery,awakening and extubation were recorded. The ramsay sedation scores at extubation and after 1 h and 2 h of extubation, the occurrence of shivering and over-sedation within 2 h after extubation were also recorded. Results:Compared with the C group,less blood loss,lower Fromme score,short operation time and lower heart rate during the controlled hypotension period in D group were found(P<0. 05 to P<0. 01). Compared with the C group,the fluctuating of mean arterial pressure and heart rate and hemodynamics in D group were smaller and stabler at the moment of endotracheal intubation and extubation ( P<0.01). The average dose of propofol and nitroglycerin in D group were significantly lower than those in C group(P <0. 01). The differences of the time of awakening and extubation between two groups were not statistically significant(P >0. 05). The Ramsay sedation scores at extubation and after 1 h of extubation in D group were higher and lower than that in C group,respectively(P<0. 01). The difference of Ramsay sedation score between two groups after 2 h of extubation was not statistically significant(P>0. 05). The incidence of shivering in D group was lower than that in C group C(P<0. 05). Conclusions:The clinical application of dexmedetomidine combined with nitroglycerin in minimally invasive resection of pituitary adenoma through nose can significantly improve the operative score, shorten operation time,obtain better sedation effect and inhibit phenomenon of excessive sedation,which is effective,practicable and safe.