右美托咪定对ASA I~Ⅱ级老年鼻内镜术患者血压控制、血流动力学及炎症反应的影响

Effects of Dexmedetomidine on the Control of Blood Pressure, Hemodynamics and Inflammatory Response in Elderly Patients Undergoing Endoscopic Sinus Surgery with ASA Level I-II

关键词:  右美托咪定  鼻内镜术  美国麻醉医师学会分级  血流动力学  炎症反应

Key words:  dexmedetomidine  endoscopic surgery  ASA classification  hemodynamics  inflammatory response

摘要:

目的 研究右美托咪定对美国麻醉医师学会（American Society of Anesthesiologists，ASA）I~Ⅱ级且行鼻内镜术的老年患者血压控制、血流动力学及炎症反应的影响。方法 选取择期鼻内镜手术的老年患者60例，ASA I~Ⅱ级，随机分为观察组和对照组（n=30）。观察组给予右美托咪定，对照组给予尼卡地平联合艾司洛尔，用于术中降压。2组均给予咪达唑仑、芬太尼、丙泊酚、阿曲库铵进行麻醉诱导，吸入七氟醚和持续静滴丙泊酚进行麻醉维持，填塞鼻腔时停用麻醉药物。于麻醉诱导前3 min （T₀）、气管插管即刻（T₁）、拔管即刻（T₂）监测心率（heart rate，HR）及平均动脉压（mean arterial pressure，MAP）。抽取T₀、T₂、术后24 h （T₃）及术后72 h （T₄）的空腹静脉血，检测相关炎症因子CRP、TNF-α、IL-6水平。观察并记录患者术中及术后麻醉并发症的发生情况。结果 2组患者各时间点时HR及MAP组间无统计学差异，组内比较T₁及T₂时间点较T₀时的HR及MAP均明显升高，T₂时间点的HR及MAP较T₁明显升高（P<0.05）；观察组Ramsay评分及降压时间均低于对照组（P<0.05）；观察组CRP、TNF-α、IL-6水平明显低于对照组（P<0.05），T₀至T₃时间段炎症指标呈现上升趋势，于T₃达到最大值，在T₄时下降，均具有统计学意义（P<0.05）；两者手术过程中均未出现术中知晓、呼吸抑制、寒战等情况，术后观察也未出现躁动等并发症。结论 ASA I~Ⅱ级老年鼻内镜术患者采用右美托咪定可平稳控制术中血压及血流动力学相关指标，有效降低炎症反应强度。

Abstract:

OBJECTIVE To study the effects of dexmedetomidine on the control of blood pressure, hemodynamics and inflammatory response in elderly patients undergoing endoscopic sinus surgery with American Society of Anesthesiologists(ASA) level I-Ⅱ. METHODS Sixty elderly patients undergoing endoscopic sinus surgery with ASA level I-Ⅱ were divided into observation group and control group(n=30). The observation group was given dexmedetomidine, while the control group was given nicardipine and esmolol for the control of blood pressure during the surgery. In both groups, midazolam, fentanyl, propofol and atracurium were given for anesthesia induction. Sevoflurane and propofol were used for anesthetic maintenance. When the nasal cavity was filled, the anesthetic was stopped. Heart rate(HR) and mean arterial pressure(MAP) were monitored at three minutes before the induction of anesthesia(T₀), immediate intubation(T₁), and immediate extubation(T₂). Fasting venous blood was collected at T₀, T₂, 24 h after operation(T₃) and 72 h after operation(T₄), and the levels of related inflammatory factors CRP, TNF-α and IL-6 were measured. The occurrence of anesthesia complications were observed and recorded during and after surgery. RESULTS There was no significant difference between the HR and MAP groups at each time point. The HR and MAP of the T₁ and T₂ time points were significantly higher than those of the T₀, and the HR and MAP of the T₂ time point was significantly higher than that of the T₁(P<0.05). Ramsay score and blood pressure reduction time in the observation group were lower than those in the control group(P<0.05). The levels of inflammatory factors in the observation group were significantly lower than those in the control group(P<0.05). The inflammatory index of T₀ to T₃ showed an upward trend, reaching the maximum at T₃, and decreasing at T₄, all had statistically significant(P<0.05). There was no intraoperative awareness, respiratory depression, chills, etc. occurred during the operation, and no complications such as agitation were observed after operation. CONCLUSION Elderly patients undergoing endoscopic sinus surgery with ASA level I-Ⅱ can use dexmedetomidine to control intraoperative blood pressure and hemodynamics indicators, effectively reducing the intensity of inflammatory response.