右美托咪定自控监护麻醉对眼鼻微创手术的影响

Effect of monitored anesthesia care with self-controlled infusion dexmedetomidine on eyes-noses minimally invasive surgery

摘要:

目的 观察右美托咪定复合舒芬太尼自控监护麻醉用于局部麻醉下行眼鼻微创外科手术患者的效果和安全性。方法 选择60例局部麻醉下行单眼泪囊开窗引流术的患者，随机分为D组（右美托咪定），DS组（右美托咪定+舒芬太尼），MF组（咪唑安定+舒芬太尼），n =20。观察并记录术晨（T0）、入室时（T1）、局部麻醉时（T2）、手术开始后10 min（T3）、开始后20 min（T4）、开始后30 min（T5）、术后30 min（T6）的平均动脉血压（MAP）、心率（HR）、脉搏血氧饱和度（SPO2）、呼吸频率（RR）、呼气末二氧化碳分压（PETCO2）、Ramsay镇静评分、鼻内窥镜术野质量评分（SESFQ）、手术时间（OT）和术中自控按压次数（CPT）。结果 3组患者T1时点MAP、HR均高于T0时点（P <0.05），DS组患者T2、T3、T4、T5和T6时点的MAP、HR低于T0时点（P <0.05），且低于D组和MS组同时间点的MAP、HR（P <0.05），D组患者T3、T4、T5和T6时点的MAP低于MS组同时点的MAB（P <0.05），且T3、T4点的MAP低于D组其他时点（P <0.05），MS组患者T5和T6时点的HR、MAP明显高于T2、T3、T4时点（P <0.01）；MS组患者T2、T3、T4、T5和T6时点的RR低于T1时点及D、DS组同时点的RR（P <0.05），PETCO2高于T1时点及D、DS组同时点的PETCO2（P <0.05），MS组T2、T3和T4时点的Ramsay评分均大于D组、DS组同时点的Ramsay评分（P <0.05），T5和T6时点的Ramsay评分均明显小于D组、DS组同时点的Ramsay评分（P <0.01）；DS组患者的CPT和SESFQ均明显少于D、MS组（P <0.01），而D组的SESFQ评分低于ＭＳ组（P <0.05）。结论 右美托咪定复合舒芬太尼自控输注较自控输注右美托咪定或咪唑安定复合舒芬太尼单次给药可更快、更有效地发挥镇静、镇痛、降低血压效应，提供良好的手术视野、缩短手术时间，且对患者呼吸功能影响甚微。

Abstract:

【Objective】 The aim of this study was to observe the efficacy and safety of monitored anesthesia care with dexmedetomidine (DEX) and sufentanil Self-controlled infusion in Eyes-noses minimally invasive surgery. 【Methods】 Sixty patients with the bilateral dacryocyst fenestration drainage surgery were randomized to group D(DEX) or group DS (DEX and Sufentanil) or group MS (Midazolam and Sufentanil), n =20. The mean arterial blood pressure (MAP), heart rate (HR), pulse oxymetry (SPO2), respiratory rate(RR), pressure of end-breathing carbon dioxide partial(PEtCO2), sedation score with ramsay, sinus-endoscopic surgical field quality (SESFQ) at the time of early in the morning (T0), entering the room(T1), operating the local anesthesia(T2), 10 min (T3), 20 min (T4),30 min (T5) after the surgery started, 30 min after operation (T6), and operating time (OT), self-controlled press times during surgery (CPT) were observed and recorded. 【Results】 MAP, HR of three groups at T1 were significantly higher than that at T0 (P ＜0.05), which of group DS at T2,T3,T4,T5,T6 were lower than that at T0 (P ＜0.01) and that of group Dand MS (P ＜0.05), which of group MS at T5,T6 were higher than that at T2,T3,T4 (P ＜0.01), while MAP of group D at T3,T4,T5,T6 were lower than that of group MS;RR of group MS at T2,T3,T4,T5,T6 were lower than which at T1 and which of group DS and D (P ＜0.05), but PEtCO2 were higher than which at T1 and which of group DS and D (P ＜0.05); Ramsay of group MS at T2,T3,T4 were higher than that of group DS and D (P ＜0.05), while which at T5,T6 were lower than that of group DS and D (P ＜0.05); CPT of group DS was significantly less than which of group D (P ＜0.01); SESFQ and OT of group DS were less than that of group D and MS (P ＜0.05). 【Conclusion】 Compared with DEX self-controlled infusion and midazolam combined sufentanil single-dose infusion, monitored anesthesia care with DEX combined sufentanil self-controlled infusion can offer good operation field and shorten the operation time by faster and more effective sedation and analgesic and lower blood pressure, and have less effect on respiratory function in patients.