摘要目的 观察右美托咪定联合复方利多卡因乳膏对功能性鼻内镜鼻窦手术(functional endoscopic sinus surgery,FESS)的影响.方法 将90例ASA分级Ⅰ级、择期全身麻醉患者,完全随机分为右美托咪定(D)组、右美托咪定+复方利多卡因乳膏(DL)组和空白对照(N)组(每组30例).D组和DL组麻醉诱导前15 min,静脉输注右美托咪定0.6 μg/kg,后以0.6 μg·kg-1·h-1持续泵注,N组静脉输注等剂量0.9％氯化钠;手术开始前15 min DL组给予1g复方利多卡因乳膏的棉球涂抹鼻腔,D组、N组用不含复方利多卡因乳膏作为对照,丙泊酚和瑞芬太尼持续泵注镇痛镇静[MAP维持于70 mmHg(1 mmHg=0.133 kPa)左右].记录手术时间、术中出血量及丙泊酚、瑞芬太尼总用量,诱导前15 min(T0)、手术开始后15 min(T1)、30 min(T2)、45 min(T3)及拔管即刻(T4)的HR、MAP,观察术野质量评分,记录PACU停留时间、拔管后警觉/镇静评分(modified assessment of alertness/sedation,MOAMS)和术后3 h VAS评分.结果 3组患者年龄、体重、性别比、手术时间比较差异无统计学意义(P＞0.05).与N组比较,D组和DL组丙泊酚和瑞芬太尼用量和术中出血量明显减少(P＜0.05),而D组与DL组之间差异无统计学意义(P＞0.05);与D组比较,DL组T0～T4时的MAP和HR差异无统计学意义(P＞0.05),N组MAP在T0～T3时差异无统计学意义(P＞0.05),T4时显著升高(P＜0.05),N组HR在T1～T4时显著升高(P＜0.05),DL和D组T4时MAP、HR显著低于T0,而N组显著高于T0(P＜0.05);D组和DL组术野质量评分优于N组(P＜0.05),D组和DL组之间差异无统计学意义(P＞0.05);与D组[(49±9)min]比较,N组PACU停留时间[(35±6) min]缩短(P＜0.05),DL组[(50±10) min]无明显变化;与D组[(3.0±0.3)分]比较,N组拔管后警觉/镇静评分[(4.5±0.5)分]升高(P＜0.05),DL组拔管后警觉/镇静评分[(2.9±0.5)分]无明显变化;与D组[(1.8±0.6)分]比较,N组VAS评分[(2.8±0.5)分]升高(P＜0.05),DL组VAS评分[(0.9±0.5)分]明显降低(P＜0.05).结论 全身麻醉鼻内镜手术中应用右美托咪定联合复方利多卡因乳膏安全有效,减少术中出血,提高手术术野质量,减少拔管反应,提高患者拔管期的舒适度和术后镇痛质量,减少麻醉药物用量.

abstractsObjective To investigate the security and efficacy of dexmedetomidine combined with compound lidocaine cream in functional endoscopic sinus surgery(FESS).Methods Ninety patients were randomly divided into 3 groups(n=30):control group (N),dexmedetomidine group (D) and dexmedetomidine +compound lidocaine cream group (DL).Patients were subject to dexmedetomidine 0.6 pg/kg iv,followed by dexmedetomidine 0.6 μg·kg1·h-1 in group D and DL and volumetric 0.9％ NaCl in group N 15 min from induction to end of operation.Thereafter,the cream of compound lidocaine in group DL and that of no compound lidocaine in group D and N was administered intranasal 15 min before operation.MAP was retained at about 70 mmHg (1 mmHg=0.133 kPa) by remifentanil and propofol.HR and MAP were recorded 15 min before induction(T0),15 min(T1),30 min(T2) and 45 min (T3) after operation and instantly after extubation (T4).The duration of operation and PACU,extubation time,amount of bleeding and dosage we re recorded.Quality of the surgical field,modified assessment of alertness/sedation (MOAA/S) score and VAS were assessed in PACU.Results There was no significant difference in age,weight,sex ratio and duration of operation between the three groups (P＞0.05).Compared with group N,doses of propofol and remifentanil and amount of bleeding in group D and DL were decreased(P＜0.05) and had no significant difference between group D and DL(P＞0.05).MAP and HR had no difference from T0 to T4 between group D and DL (P＞O.05).Compared with group D,MAP had no significant difference from T0 to T3 (P＞0.05) and increase at T3 in group N while HR increase from T0 to T4 (P＜0.05).MAP or HR in group DL and D were lower at T4 (P＜0.05) and in group N higher than at T0 (P＜0.05).Residence time in PACU was decreased in group N [(35±6) min](P＜0.05) and had no difference in group DL [(50±10) min] compared with group D [(49±9) min](P＞0.05).SSFQ in group D and DL were better than that in group N (P＜0.05) and had no difference between group D and group DL (P＞0.05).MOAA/S score was increased in group N (4.5±0.5)(P＜0.05) and had no difference in group DL (2.9±0.5) compared with group D (3.0±0.3)(P＞0.05),while VAS was increased in group N (2.8±0.5) (P＜0.05) and decreased in group DL (0.9±0.5) (P＜0.05) compared with group D (1.8 ±0.6).Conclusions Application of dexmedetomidine combined with compound lidocaine cream is feasible and safe during FESS.It shows good quality of the surgical field,reduced extubation reaction and good postoperative comfort.