右美托咪定联合帕瑞昔布钠对鼻内镜手术苏醒期躁动及术后早期镇痛的影响

Effects of Dexmedetomidine combined with Parecoxib sodium on emergence agitation and early postoperative analgesia after endoscopic sinus surgery

摘要:

目的 探讨帕瑞昔布钠联合右美托咪定（DEX）对鼻内镜手术苏醒期躁动的影响。方法 选择2020年1月－2021年2月该院择期行全身麻醉下鼻内镜手术的患者104例。采用随机数表法分为实验组（DEX + 帕瑞昔布钠组，DP组）和对照组（DEX，D组），各52例。两组患者麻醉诱导前，分别给予静脉输注DEX 0.5 μg/kg，输注10 min，然后持续泵注0.4 μg/（kg·h），手术结束前30 min停药。DP组DEX停药后立即给予帕瑞昔布钠40 mg静注。采用Ricker镇静-躁动评分（RSAS）评估两组患者拔管时及拔管后5 min躁动评分，视觉模拟评分法（VAS）评估患者术后2、4、8、12和24 h疼痛情况。比较两组患者苏醒期RSAS评分、术后VAS评分、恶心呕吐、鼻出血和胃肠道不适的发生率。结果 与D组比较，DP组苏醒期RSAS明显降低［（3.6±0.7）和（4.0±0.8）分，（3.8±0.4）和（4.0±0.2）分，P < 0.05］，术后2、4和8 h VAS明显降低（P < 0.05）。两组患者术后恶心、呕吐、鼻出血和胃肠道不适等并发症发生率比较，差异均无统计学意义（P > 0.05）。结论 帕瑞昔布钠联合DEX用于鼻内镜手术可以降低苏醒期RSAS评分，在术后早期具有良好的镇痛效果。

Abstract:

Objective To investigate the effect of Parecoxib sodium combined with Dexmedetomidine (DEX) on restlessness during the recovery period of endoscopic sinus surgery.Methods From January 2020 to February 2021, 104 patients underwent endoscopic sinus surgery under general anesthesia. All the patients were randomly divided into experimental group (DEX plus Parecoxib sodium group, DP group) and control group (DEX group, D group), with 52 cases in each group. Before induction of anesthesia, DEX 0.5 μg/kg was given intravenously for 10 min, then 0.4 μg/(kg·h) was continuously pumped, and the drug was stopped 30 min before the end of operation. In DP group, Dexmedetomidine was given 40 mg intravenous injection immediately after stopping the drug. Ricker sedation-agitation scale was used to evaluate the restlessness scores of the two groups during extubation and 5 min minutes after extubation. Visual analogue scale (VAS) was used to evaluate the pain scores of patients at 2, 4, 8, 12 and 24 h after operation. RSAS and VAS after operation, incidence of nausea and vomiting, epistaxis and gastrointestinal discomfort were compared between the two groups.Results Compared with D group, the RSAS of DP group was significantly lower during the recovery period [(3.6 ± 0.7) vs (4.0 ± 0.8), (3.8 ± 0.4) vs (4.0 ± 0.2) ], and the VAS was lower at 2, 4 and 8 h after operation (P < 0.05). There were no significant difference in the incidence of postoperative nausea and vomiting, epistaxis and gastrointestinal discomfort between the two groups (P > 0.05).Conclusion The combination of Parecoxib sodium and DEX in nasal endoscopic surgery can reduce the RSAS in recovery period and has a good analgesic effect on early postoperative pain.