中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (1): 62-65.

• 论著 • 上一篇    下一篇

右美托咪定在口腔颌面外科正颌手术控制性降压中的作用

张凌， 朱莹   

  1. 上海交通大学医学院附属第九人民医院 麻醉科,上海 200011
  • 收稿日期:2015-03-02 出版日期:2016-01-20 发布日期:2016-02-01
  • 通讯作者: 朱莹,E-mail：zhuying511@126.com
  • 作者简介:张凌（1978-）,女,在读硕士研究生,主治医师,E-mail：zhangling_zl78@126.com

Study of controlled hypotension by dexmedetomidine in orthognathic surgery

ZHANG Ling, ZHU Ying   

  1. Department of Anesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011,China
  • Received:2015-03-02 Online:2016-01-20 Published:2016-02-01

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被引次数

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摘要： 目的 观察复合右美托咪定在口腔颌面外科正颌手术控制性降压中的作用。方法 选取正颌手术患者40例,ASA I-II级。随机分为D组（右美托咪定组20例）和NS组（0.9%氯化钠溶液组20例）。手术开始前10 min,D组以1.0 μg/kg剂量推注泵静脉推注10 min,随后以0.5 μg/(kg·h)持续输注并联合异丙酚和瑞芬太尼行控制性降压。NS组用0.9%氯化钠溶液持续静脉泵输注,方法和剂量与D组相同。2组均以平均动脉压（MAP）维持在55~65 mmHg为目标。记录2组在诱导及降压前、后各个时间段的心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）的值;比较2组术中异丙酚和瑞芬太尼的用量;同时根据Fromme术野评分表评定手术视野质量。采用SPSS11.0软件包进行统计学分析。结果 控制性降压期间,2组MAP值均显著低于诱导前（P<0.01）。D组在T3(手术开始)、T4(手术开始后15 min)、T5(手术开始后30 min)时MAP和HR明显低于NS组（P<0.05）。NS组HR在T3、T4、T5、T6（手术开始后 60 min）时显著高于诱导前（P<0.05）。D组的异丙酚用量显著低于NS组（P<0.05）,同时D组的术野评分显著优于NS组（P<0.05）。结论 右美托咪定用于口腔颌面外科正颌手术的控制性降压,安全有效,同时可以防止心率、血压波动,使血流动力学更加平稳,并且减少异丙酚的用量,使术野质量更加清晰。

关键词: 右美托咪定, 控制性降压, 正颌手术

Abstract: PURPOSE : To observe the effect and safety of controlled hypotension by dexmedetomidine in oral maxillofacial orthognathic surgery. METHODS : Forty patients undergoing orthognathic surgery were randomly divided into 2 groups: group D received dexmedetomidine (n=20), group NS received normal saline (n=20).After induction before the operation, dexmedetomidine 1.0 μg/kg was given intravenously within 10 min, then maintained at 0.5 μg/(kg·h) in group D, the same maintained speed of normal saline was given in group NS .Both groups were combined with propofol, remi-fentanyl, sevoflurane for controlled hypotension. The target MAP was maintained at 50-65 mmHg. HR, SBP, DBP and MAP were recorded before anesthesia and during the phase of controlled hypotension. And the dosage of propofol and remi-fentanyl in both groups was compared; meanwhile, the scores of surgical field quality (SSFQ) were assessed according to Fromme surgical field quality list. SPSS 11.0 software package was used for comparison of the 2 groups. RESULTS : During controlled hypotension ,MAP in both groups were significantly lower than those before anesthesia (P<0.01). MAP and HR in group D at T3(at the beginning of surgery), T4(15 min after surgery ), T5( 30 min after surgery) were significantly lower than that of group NS (P<0.05). HR in group NS at T3, T4, T5, and T6(60 min after surgery) were significantly higher than those before anesthesia (P<0.05). The dosage of propofol in group D was significantly lower than that in group NS (P<0.05). Compared with group NS, surgical field quality in group D were significantly better (P<0.05). CONCLUSIONS : Dexmedetomidine can be used safely and efficiently for controlled hypotension in oral maxillofacial orthognathic surgery, combined use of dexmedetomidine can avoid fluctuation in blood pressure and heart rate, make the hemodynamics more stable, and reduce the dosage of propofol, and achieve better surgical field quality.

Key words: Dexmedetomidine, Controlled hypotension, Orthognathic surgery

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