Application Of Dexmedetomidine Combined Isosorbide Dinitrate Controlled Hypotension In Nasal Endoscopic Surgery

Objective: To investigate the feasibility of controlled decompression of dexmedetomidine combined with isosorbide dinitrate in endoscopic sinus surgery,and to find the controlled decompression of dexmedetomidine plus isosorbide dinitrate in nasal endoscopic surgery.The optimal dose and investigate the effect of dexmedetomidine on hemodynamics in the short term after surgery.Methods: A total of 120 patients undergoing elective endoscopic surgery were enrolled,including 73 males and 47 females,aged 18-60 years,and ASA grade I-II grade.They were randomly divided into 4 groups with 30 cases in each group.Dexmedetomidine 0.4ug/kg(group D1),dexmedetomidine 0.6?g/kg(group D2),dexmedetomidine 0.8?g/kg(group D3)and normal saline(group C),capacity All were 10 ml,pumping was completed 10 minutes before induction of general anesthesia;all four groups were started to pump isosorbide dinitrate 2ug/kg/min when the speculum into the nasal cavity for controlled decompression,and according to the target mean arterial pressure at any time Sorbitol speed.Four groups of patients were recorded at the time of admission(T1)HR,MAP,and the time taken for each group to reach the target blood pressure(70% of the MAP at the time of admission)and the average amount of isosorbide dinitrate used during the operation [the total amount of isosorbide dinitrate/(Patients' body weight × total blood pressure time),Fromme Surgical Field Quality Score(SSFQ),the incidence of central bradycardia in each group,the patient's wake-up time in PACU,the conscious sedation score in Ramsay's recovery period,VAS pain score,2h(T2)MAP,HR.Results: Compared with T1,the HR of dexmedetomidine group(D1-D3 group)was significantly slower at T2(P<0.05),and the HR of the control group(C group)was significantly higher(P<0.05);T2 and The HR difference values at the T1 time point were compared between the D1-D3 groups.The D3 group>D2 group>D1 group(P<0.05).The D3 group had the greatest HR difference(-12.87±2.569)/min,indicating that dexmedetomidine The effect of DH slowed down in a dose-dependent manner;compared with T1,there was no significant difference in MAP between T2 and T1(P>0.05),suggesting that dexmedetomidine has no significant effect on blood pressure in the short term after surgery..The four groups were compared in pairs and reached the target blood pressure in the time of D3 <D2 <D1<C,D3 was the shortest time to reach the target blood pressure,(5.57±0.59)min(P<0.05),proved dexmedetomide Pyrimidine can shorten the time to reach the target blood pressure;VAS score D3 group <D2 group <D1 group <C group(P<0.05),D3 group VAS score lowest(1.00 ± 0.643)(P<0.05);Fromme surgery field quality score The conscious sedation scores of Ramsay's recovery period were higher in D3 group,D2 group,D1 group,C group(P<0.05),and the highest scores in D3 group were(4.00±0.525)(P<0.05)and(2.83±0.747)(P<0.05),suggesting that dexmedetomidine has analgesic,sedative,and hemorrhagic effects in a dose-dependent manner;dexmedetomidine group is superior to the control group and is dose-dependent,but the surgery center has been The incidence of palliative rate was highest in group D3> D2> group D1> group C,and the incidence of bradycardia was highest in group D3(20%)(P<0.05);the time of awake extubation in the PACU,dexmedetomidine group There was no statistical difference(P>0.05)with the control group(19.01±1.97)min,suggesting that dexmedetomidine did not affect the time of extubation in the recovery room.Conclusion: Dexmedetomidine-controlled isosorbide dinitrate can reduce the time to reach the target blood pressure,reduce intraoperative blood loss,improve the quality of the surgical field,and does not affect the patient's extubation time in the recovery room.,To reduce the occurrence of postoperative restlessness and pain,to maintain the stability of hemodynamics in the short term after operation,and to suppress the occurrence of rebounding heart rate caused by the withdrawal of isosorbide dinitrate,but not to save the dosage of isosorbide dinitrate.,And the application of dexmedetomidine overdose will increase the incidence of bradycardia,it is recommended to use 0.6ug/kg dexmedetomidine combined isosorbide dinitrate control of blood pressure.