不同剂量右美托咪定对鼻窦手术患者应激反应和苏醒质量的影响

发布时间：2018-03-16 01:11

本文选题：右美托咪定　切入点：功能性鼻内镜鼻窦手术　出处：《广东医学》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨不同剂量右美托咪定复合丙泊酚-瑞芬太尼持续静脉泵注对功能性鼻内镜鼻窦手术(FESS)患者围手术期的血流动力学、应激反应及苏醒质量的影响。方法选择行择期FESS患者80例,随机分为4组(n=20):生理盐水组(C组)、右美托咪定0.3μg/(kg·h)组(D1组)、右美托咪定0.5μg/(kg·h)组(D2组)、右美托咪定0.7μg/(kg·h)组(D3组)。D1、D2、D3组分别在麻醉诱导前10 min静脉输注负荷量右美托咪定0.6μg/kg(以生理盐水稀释成4μg/m L,10 min完成),术中给予维持剂量右美托咪定分别为0.3μg/(kg·h)、0.5μg/(kg·h)及0.7μg/(kg·h)至手术结束前10 min,C组以同样方式静脉输注生理盐水。记录麻醉诱导前(T0)、气管插管后1 min(T1)、手术开始(T2)、拔管前(T3)、拔管后10 min(T4)各时点的HR、MAP。检测术中T0、T1、T4时点血浆皮质醇(COR)、肾上腺素(ADR)水平。观察并记录患者呼叫睁眼时间、自主呼吸恢复时间、拔管时间以及术后发生心动过缓、高血压等不良反应情况,并进行镇静-躁动SAS评分和Ramsay镇静评分。结果(1)与T0比较,T1、T2时C组HR、MAP明显升高(P0.05)。D1、D2、D3组HR、MAP明显低于C组(P0.05)。T4时C组HR、MAP较T0时明显升高(P0.05),D1、D2、D3组均低于C组(P0.05),D3组HR低于D1、D2组(P0.05)。(2)T1、T4时,C组COR、ADR较T0时明显升高(P0.05),且D1、D2和D3组COR、ADR低于C组(P0.05),T4时点,C和D1组COR浓度高于D2组和D3组(P0.05)。(3)D1、D2、D3组患者呼叫睁眼、自主呼吸恢复及拔管时间与C组比较差异无统计学意义(P0.05)。在T4时点,C组SAS评分明显高于D1、D2、D3组(P0.05)。D1、D2、D3组患者Ramsay镇静评分显著高于C组(P0.05)。结论右美托咪定复合丙泊酚-瑞芬太尼持续输注用于FESS,患者围手术期的血流动力学更稳定,能降低围术期的应激反应,提高麻醉苏醒质量,0.5μg/(kg·h)右美托咪定是FESS患者较合适的临床应用剂量。
[Abstract]:Objective to investigate the hemodynamics of patients with different doses of dexmetomidine combined with propofol and remifentanil for functional endoscopic sinus surgery (FESS) during perioperative period. Methods 80 patients with selective FESS were selected. They were randomly divided into 4 groups: normal saline group, dexmetomidine 0.3 渭 g / kg 路h) group D _ 2, right metoimidine 0.5 渭 g / kg 路h) group D _ 2, D _ 3 group (0.7 渭 g / g / kg 路h) group D _ 3 group, group D _ (1) D _ 2D _ (3) group received intravenous infusion of dexmetomidine 0.6 渭 g / kg 10 min before induction of anesthesia (with dexmetomidine 0.5 渭 g / kg 路h), group D _ 3 received intravenous infusion of dextromidine 0.6 渭 g 路kg ~ (-1) before anesthesia induction, and group D _ 3 received dextromidine at a dose of 0.6 渭 g 路kg ~ (-1) 路h ~ (-1) before anesthesia induction. Normal saline was diluted into 4 渭 g / mL for 10 min. The maintenance dose of dexmetomidine was 0.3 渭 g / kg / kg / h and 0.7 渭 g / kg / kg / h, respectively. 10 minutes before the end of operation, normal saline was infused intravenously in group C (n = 10). Before anesthesia induction and 1 min after tracheal intubation, normal saline was infused intravenously in group C, and T0 was recorded before anesthesia induction, 1 min after tracheal intubation, 1 min after tracheal intubation, and 1 min after tracheal intubation. HRMAPs were observed at different time points (T0 ~ T1 ~ T4). Plasma cortisol Corr, adrenocephalin (ADR) levels were measured at T0 / T1 / T4 time points. The time of eye opening was observed and recorded. Spontaneous respiratory recovery time, extubation time, postoperative bradycardia, hypertension and other adverse reactions, Results compared with T0, HRMAP in group C was significantly higher than that in group C (P 0.05N 路D _ 1D _ 2T _ 3) and HRMAP in group C was significantly lower than that in group C (P 0.05N 路T _ 4). The HRMAP in group C was significantly higher than that in group C (P 0.05 D _ 1D _ 2D _ 3) than that in group C (P _ (0.05) P _ (0.05)) T _ (1) T _ (4) was significantly lower than that in group C (P _ (0.05) P _ (0.05)) and T _ (1) T _ (4) in group C was significantly lower than that in group C (P < 0.01). The concentration of COR in group D _ 1 and D _ 3 was significantly higher than that in group D _ 2 and D _ 3, and the concentration of COR in group D _ 1 and D _ 3 was higher than that in group D _ 2 and D _ 3, respectively, and the level of COR in group D _ 1 and D _ 3 was higher than that in group D _ 2 and D _ 3, and the concentration of COR in group D _ 1 and D _ 3 was higher than that in group D _ 2 and D _ 3, respectively. There was no significant difference in the time of spontaneous respiration recovery and extubation between group C and group C. the SAS score in group C was significantly higher than that in group D 1, D 2, D 3, P 0 05, P 0 05, P 0 05, P 0 05, P 0 05, P 0 05, respectively. Conclusion the Ramsay sedation score of group C is significantly higher than that of group C (P 0. 05). Continuous infusion of fentanyl to FESS resulted in more stable hemodynamics during the perioperative period. It can reduce the stress response in perioperative period and improve the anaesthesia recovery quality of 0.5 渭 g / kg 路h. Dexmetomidine is a more suitable clinical dose for FESS patients.
【作者单位】：宁夏医科大学总医院心脑血管病医院麻醉科;
【基金】：宁夏医科大学2014年校级科研项目(编号:XM201445)
【分类号】：R614

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