曹德钧　王芳　刘少星

[摘要]目的：观察右美托咪啶用于局麻下隆鼻手术的安全性和可行性。方法：40例ASA分级Ⅰ～Ⅱ级择期在局麻行隆鼻手术的患者，随机分为对照组和观察组，每组20例。观察组以右美1μg/kg 的负荷量10min泵入后，继之以0.3μg/（kg·h）持续泵注至手术结束前30min；对照组持续泵注等容量的生理盐水。记录两组给药即刻及给药后5、15、30、45min的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SPO2）及Ramesay评分。手术结束时采动脉血测定血浆去甲肾上腺素（NE）和肾上腺素（E）的浓度。结果：结果观察组给药15min后的各时间点HR 逐渐下降，但稳定于60次/min左右；在15min时点MAP轻度升高，然后恢复正常；SPO2无明显变化；Ramesay评分逐渐增加，与对照组同时点、同组T0比较 （P

[关键词]隆鼻手术；局部麻醉；右美托咪啶；镇静；应激

[中图分类号]R62 [文献标识码]A [文章编号]1008-6455（2014）20-1693-03

The clinical observation with dexmedetomidine for rhinoplasty surgery under local anesthesia

CAO De-jun1，WANG Fang2，LIU Shao-xing1

（1.Deparment of Anesthesiology，The Second People's Hospital of Chengdu，Chengdu 610017，Sichuan，China；2.Deparment of Anesthesiology，Headquarters Hospital of Chengdu Military Command）

Abstract： Objective To evaluate the safety and feasibility of the dexmedetomidine for rhinoplasty surgery under local anesthesia. Methods 40 cases of ASA grade Ⅰ～Ⅱ level in patients undergoing elective surgery under local anesthesia line rhinoplasty randomly divided into control group and observation group，20 cases each. After loading the observation group to the dexmedetomidine 1μg/kg pumped 10min， followed by 0.3μg/（kg·h） continuous infusion until the end of the surgery 30min； the control group continued infusion volume of saline. Record two administration immediately after administration 5，15，30，45 min and mean arterial pressure （MAP），heart rate （HR），pulse oximetry （SPO2） and Ramesay score.Mining arterial plasma norepinephrine （NE） and epinephrine （E） when the concentration of surgical outcome. Results Administration observation group at each time point after 15min HR gradually decreased，but stabilized at 60 beats/min； MAP mildly elevated point in 15min， then returned to normal， Ramesay score gradually increased over the same period compared with the control group （P<0.05）. Postoperative NE and E concentrations lower than the control group （P<0.05）. Conclusion Rhinoplasty surgery in local anesthesia by intravenous infusion into the dexmedetomidine can get a good sedative effect，respiratory and circulatory stable postoperative stress response lighter， conducive to the smooth conduct of surgery， and secure.

Key words：rhinoplasty； local anesthesia； dexmedetomidine； sedation； stress

在整形美容医学中，隆鼻手术已经成为一种比较常见的手术[1]，随着人民生活的水平质量的提高，对该手术的安全性和舒适性的要求也越来越高，而且有些患者要求在手术过程中亲自看到隆鼻所用假体的植入过程。这给隆鼻手术的麻醉提出了更高的要求，既要保证绝对的安全舒适又要使患者能够在术中和整形美容医师进行交流。近年来，临床上开始广泛应用一种新型麻醉辅助用药右美托咪啶，它是一种高选择性的α2肾上腺素受体激动剂，能产生镇静、镇痛、抗焦虑作用，并具有特殊的“可唤醒”镇静效果。本次研究将右美托咪啶创新性的应用于局麻下的隆鼻手术，满足了上述要求取得了比较满意的临床麻醉效果，现报道如下。……