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目的研究老年颌面外科手术中采用右美托咪啶镇静复合局部麻醉效果。方法从天津市口腔医院颌面外科择期手术者中选择60例老年患者(ASAⅠ~Ⅲ级,年龄60~80岁),随机分为右美托咪啶组(D组)和单纯局麻组(B组)。D组入手术室后开放静脉,10 min内静脉输注0.5μg/kg剂量的右美托咪啶,再用2 ml阿替卡因局部麻醉手术部位后开始手术。在手术过程中持续静脉输注0.3μg(kg·h)的右美托咪啶至术毕。B组入手术室后手术部位注射2 ml局麻药阿替卡因后开始手术。为了减少体动反应对手术的干扰,两组均可间断追加局麻药。手术过程中监测心率、平均动脉压、血氧饱和度、脑电双频指数(bispectral index,BIS)数值,记录术中心血管活性药物的用量、心血管不良事件及呼吸循环抑制等不良反应的发生情况;并进行Ramsay镇静评分、镇静镇痛满意度评分、手术舒适度评分和VAS疼痛评分。结果相比B组,D组的血流动力学变化小、无缺氧及呼吸抑制、呛咳和躁动发生。D组患者术后Ramsay镇静评分和术后满意度评分均较B组升高(P<0.05)。结论右美托咪啶可以提高老年颌面外科患者术中的镇静效果并具有良好的安全性。
Objective To study the effect of dexmedetomidine combined with local anesthesia in the treatment of geriatric maxillofacial surgery. Methods Sixty elderly patients (ASAⅠ ~ Ⅲ, aged 60-80 years) undergoing maxillofacial surgery in Tianjin Stomatological Hospital were randomly divided into two groups: the dexmedetomidine group (D group) and the simple local anesthesia group Group B). D group into the operating room after the opening of the vein, 10 min intravenous infusion of 0.5μg / kg dose of dexmedetomidine, and then 2 ml of articaine local anesthesia surgery site after surgery. During the operation, 0.3 μg (kg · h) of dexmedetomidine was continuously infused intravenously. B group into the operating room after injection of 2 ml local anesthetic articaine surgery began. In order to reduce the interference of body motion response to surgery, both groups can intermittently add local anesthetics. Heart rate, mean arterial pressure, oxygen saturation, bispectral index (BIS) values during surgery, adverse cardiovascular events and adverse cardiovascular events were monitored during surgery. The Ramsay sedation score, sedation analgesia satisfaction score, surgical comfort score and VAS pain score were also evaluated. Results Compared with group B, group D had less hemodynamic changes, no hypoxia, respiratory depression, cough and restlessness. The postoperative Ramsay sedation scores and postoperative satisfaction scores of patients in group D were significantly higher than those in group B (P <0.05). Conclusion Dexmedetomidine can improve the sedation of elderly patients with maxillofacial surgery and has good safety.