右美托咪定在鼻內鏡手術中的應用及對出血、應激反應的影響

于霖 庾燕君 韓琪 廖永強

【摘要】 目的：探討右美托咪定在鼻內鏡手術中的應用及對出血、應激反應的影響。方法：選擇2017年9月-2019年1月行鼻內鏡手術的患者80例，按隨機數字表法分為觀察組與對照組，各40例。兩組均靜脈注射丙泊酚2 mg/kg，芬太尼0.2 mg，阿曲庫銨0.6 mg/kg;觀察組給予右美托咪定0.5 μg/kg以60 mL/h速度注射并以0.5 μg/（kg·h）維持至術畢，而對照組給予相同劑量的0.9%氯化鈉溶液。觀察并記錄兩組進入手術室（T0）、氣管插管前（T1）、氣管插管后（T2）、拔除氣管插管1 min（T3）、拔除氣管插管5 min（T4）的平均動脈壓（MAP）、心率（HR）及SpO2。比較兩組術野質量、術中出血量、手術時間、嗆咳評分、躁動評分≥5級以上例數及Ramsay鎮靜評分。結果：觀察組在T2～T4時的HR與MAP均低于對照組（P<0.05）;觀察組術野質量優于對照組（P<0.05），觀察組術中出血量少于對照組（P<0.05）;觀察組嗆咳評分、躁動評分≥5級以上例數及Ramsay鎮靜評分均低于對照組（P<0.05）。結論：鼻內鏡手術中應用右美托咪定可以穩定HR和MAP，減少術中出血量，降低患者的應激反應，值得臨床推廣。

【關鍵詞】 右美托咪定 鼻內鏡手術 術中出血量 血流動力學

[Abstract] Objective： To investigate the application of Dexmedetomidine in endoscopic surgery and its influence on hemorrhage and stress response. Method： A total of 80 patients underwent endoscopic nasal surgery from September 2017 to January 2019 were selected and divided into observation group and control group according to the random number table method， 40 cases in each group. Propofol 2 mg/kg， Fentanyl 0.2 mg and Atracurium 0.6 mg/kg were injected intravenously in both groups. The observation group was given Dexmedetomidine 0.5 μg/kg at a rate of 60 mL/h and maintained at 0.5 μg/（kg·h） until completion of the surgery， while the control group was given the same dose of 0.9% Sodium Chloride Solution. The average arterial pressure （MAP）， heart rate （HR） and SpO2 in the two groups were observed and recorded before entering the operating room （T0）， before endotracheal intubation （T1）， after endotracheal intubation （T2）， after endotracheal intubation was removed for 1 min （T3）， and after endotracheal intubation was removed for 5 min （T4）. The quality of the surgical field， the intraoperative blood loss， the operation time， the cough scores， the number of patients with agitation score≥5 and Ramsay sedation scores were compared between the two groups. Result： The HR and MAP of the observation group at T2-T4 were both lower than those of the control group （P<0.05）. The quality of operative field in the observation group was better than that in the control group （P<0.05）. The intraoperative blood loss in the observation group was lower than that in the control group （P<0.05）. The cough score， the number of patients with agitation score≥5 and Ramsay sedation score in the observation group were lower than those in the control group （P<0.05）. Conclusion： The application of Dexmedetomidine in nasal endoscopic surgery can stabilize HR and MAP， reduce the intraoperative blood loss and the stress response， it is worthy of clinical promotion.