朱卓丽 邓玉萍 黄焕森

[摘要] 目的 觀察持续输注不同剂量右美托咪定对内镜鼻窦手术中血流动力学、麻醉复苏质量的影响。 方法 选择广州医科大学附属第二医院2014年6月～2015年3月择期内镜鼻窦手术成年患者60例，按照随机数字表法分为三组，每组各20例，D1组、D2组于术前泵注右美托咪定负荷剂量0.5 μg/kg，随后分别予0.2、0.5 μg/（kg·h）持续泵注至手术结束，C组给予同容量生理盐水。记录各组麻醉药用量、血流动力学变化、复苏时间、复苏期Ricker镇静-躁动评分（SAS）、躁动评分（EA）及不良事件。 结果 D1组及D2组丙泊酚用量少于C组（P < 0.05），D2组瑞芬太尼用量少于D1组及C组（P < 0.05）。D1组、D2组在气管插管后即刻、术中及气管拔管时收缩压（SBP）、舒张压（DBP）及心率（HR）均较C组降低（P < 0.05）。气管拔管时D2组患者SAS、EA评分低于C组及D1组（P < 0.05）。D2组患者恶心、寒颤的发生率少于C 组及D1组（P < 0.05）。 结论 内镜鼻窦手术持续输注0.5 μg/（kg·h）右美托咪定，有利于维持血流动力学平稳，不延长麻醉复苏时间，减少术中丙泊酚及瑞芬太尼用量。

[关键词] 右美托咪定；静脉输注；内镜鼻窦手术；Narcotrend指数；血流动力学

[中图分类号] R614 [文献标识码] A [文章编号] 1673-7210（2016）03（a）-0004-05

Effects of Dexmedetomidine infusion on hemodynamics and recovery quality in sinus surgery

ZHU Zhuoli DENG Yuping HUANG Huansen

Department of Anesthesiology， the Second Affiliated Hospital of Guangzhou Medical University， Guangdong Province， Guangzhou 510260， China

[Abstract] Objective To observe the effects of continuous infusion of different doses Dexmedetomidine （Dex） on hemodynamics， recovery quality in patients undergoing endoscopic sinus surgery. Methods From June 2014 to March 2015， in the Second Affiliated Hospital of Guangzhou Medical University， 60 patients scheduled for elective endoscopic sinus surgery in t were selected， they were divided into three groups， according to random number table. 0.5 μg/kg Dex was infused within 10 min in group D1 and group D2 before anesthesia induction， sodium chloride was infused at the same volume in group C. Propofol and Remifentanil consumption， blood pressure， heart rate （HR）， recovery time， Riker Sedation-Agitation scale （SAS）， Emergence agitation scale （EA） and recovery period adverse events of three groups were recorded. Results Compared with group C， the requirement for Propofol was significantly decreased in group D1 and group D2 （P < 0.05）. Consumption of Remifentanil was significantly lower in group D2 compared with group D1 and group C （P < 0.05）. SBP， DBP and HR in group D1 and group D2 were significantly lower that those in groups C during intubation and extubation （P < 0.05）. Compared with group C and group D1，the SAS and EA scale decreased in group D2 at extubation （P < 0.05）. The incidence of nausea and shiver were lower in group D2 compared with group D1 and group C （P < 0.05）. Conclusion Dexmedetomidine at a dose of 0.5 μg/（kg·h） can effectively attenuate the cardiovascular side effects for patients undergoing endoscopic sinus surgery， attenuate the stress response induction and rapid recovery during anesthesia. Additionally it can reduced the consumption of Propofol and Remifentanil.

[Key words] Dexmedetomidine； Intravenous infusion； Endoscopic sinus surgery； Narcotrend Index； Hemodynamics

内镜鼻窦手术由于视野清晰、利于精细操作而广泛用于临床，但鼻窦手术刺激较大，术中需要充分的镇静及镇痛，维持术中血流动力学平稳，避免患者体动、呛咳影响手术操作，以减少术中出血，在麻醉恢复期能快速苏醒，又能有恰当的苏醒后镇痛，才能避免循环大幅波动、躁动等引起术野再次出血[1-3]。右美托咪定（Dexmedetomidine，Dex）是一种高选择性的α2肾上腺素受体激动剂，有研究报道在麻醉手术前单次使用Dex能减少功能性鼻内镜手术患者术后躁动发生率[4-6]，而在内镜鼻窦手术中持续输注Dex的研究尚少。本研究旨在观察内镜鼻窦手术中持续输注不同剂量Dex，其对患者术中血流动力学、麻醉复苏质量的影响，探讨术中Dex持续输注的合适剂量。

1 资料与方法

1.1 一般资料

选取2014年6月～2015年3月广州医科大学附属第二医院择期全麻内镜鼻窦手术成年患者60例，所有患者均为年龄65岁以下，ASAⅠ～Ⅱ级；……