| Objective:Dexmedetomidine set of auxiliary controlled hypotensio-n in endoscopic sinus surgery under general anesthesia in the applicatio-n, to evaluate its perioperative hemodynamics, stress response and the impact of anesthesia and postoperative recovery.Methods:Thirty patients, ASAⅠ～Ⅱ, scheduled for the endoscopic sinus surgery, were randomly divided into two groups:Dexmedetomidine group (group D) and saline group(group C),each group is fifteen. Dexmedetomidine group given 0.4μg/(kg·h) continuous infusion rate of dexmedetomidine given auxiliary controlled hypotension, two groups were remifentanil 0.25μg/(kg·min) continuous infusion,propofol target-controlled infusion to controlled hypotension. Thirthy minutes before operation finished, disable the muscle relaxant, disable all drugs when stuffing Hemostatic Gauze,then intravenous fentanyl and ndansetron. Recorded in the records of patients before anesthesia (TO), before controlled hypotension (T1), step-down after 5min (T2), lOmin (T3),20min (T4),30min (T5) and the withdrawal time (T6), stop the buck after 2min (T7),5min (T8), lOmin (T9),15min (T10), recovery extubation (T11), after extubation 5min (T12), 10min (T13),15min (T14) of the SBP,DBP,MAP,HR,RPP,SpO2,and collecting T1, T5, T9, T13 moment measured arterial blood lactate (Lac), glucose (BG) values, dual-site sandwich enzyme-linked immunosorbent assay (ELISA) measurement of serum cortisol (Cor) levels. Record blood loss, urine output, the dose of propofol, the amount of nitroglycerin, esmolol dosage and duration of surgery; also observed in blood pressure after discontinuation of surgery recovery time, with or without anti-jump hypertension, the patient recovery time of spontaneous breathing, opening eyes and call, wake extubation time, postoperative adverse events as well as the Aldrete score of 10min after extubation. Surgery fell surgical field quality rating according to Fromme operative field score table.Results:1,Hemodynamic:Prior to extubation after discontinuation compared with TO, D group at T7, MAP decreased significantly (P> 0.05), while the C group at T7andT8, MAP was significantly lower than TO (P<0.05); MAP in two groups of patients was before and after comparison of blood pressure was no significant difference (P> 0.05). Two groups of patients with HR and RPP in controlled hypotension during the period before extubation after stopping each time point was no significant difference (P>0.05). Recovery from anesthesia compared with those before anesthesia TO, C group at each time point after extubation, MAP was significantly higher than TO (P<0.05), mainly in the systolic blood pressure; and D groups was no significant difference (P> 0.05); and HR and RPP at each time point after extubation was no significant difference (P>0.05).2,Blood loss and operative field score:two groups'Fromme surgical field quality rating has no significant difference (P> 0.05), but the D group of blood loss (146.00±63.87ml) was significantly less than the C group (360.00±96.18ml) (P<0.05); D group propofol (766.00±32.09mg) was significantly less than the C group (1326.00±198.44mg) (P<0.01); in the amount of the nitroglycerin, C group of 15 patients,5 patients (33.33%) can be assisted with nitroglycerin reduced the target value of MAP, while the D group, no case can be used in patients with secondary standards,difference between the two groups was statistically significant (X2=6.000, P=0.014). 3,Biochemical indicators:between the two groups, D group, serum cortisol concentrations in T5, T9, T13 four time points was significantly lower than C group (P<0.05); compared with the T1 time point, the two groups at each time point serum cortex Alcohol showed no significant difference (P> 0.05). Between the two groups and the group of four time points of glucose, lactate had no significant difference (P> 0.05).4,Anesthesia recovery:comparison between two groups, D group was significantly shorter recovery time of spontaneous breathing (P <0.05); call the opening eyes, extubation time were not significantly different (P> 0.05). the Aldrete score of 10min after extubation between the two groups was no significant difference (P> 0.05); with the C group, D group had significantly reduced agitation and chills (P<0.05); nausea, vomiting, with or without surgery In knowing there was no significant difference (P> 0.05).Conclusion:1. Dexmedetomidine given adjuvant controlled hypotension in endoscopic sinus surgery under general anesthesia is safe and feasible,it can provide stable perioperative hemodynamics,a good surgical field quality,make patient awake rapidly and emergence completely.2. Dexmedetomidine continuous infusion can be effective in reducing the amount of propofol, and may reduce perioperative stress response. |
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