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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1.0μg/kg剂量推注泵静脉推注10 min,随后以0.5μg/(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 mm Hg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。
Objective: To observe the effect of compound dexmedetomidine on controlled hypotension of oral and maxillofacial surgery in orthognathic surgery. Methods: Forty patients with ASA I-II were selected for orthognathic surgery. Randomly divided into group D (dexmedetomidine 20 cases) and NS group (0.9% sodium chloride solution group 20 cases). 10 minutes before the start of surgery, group D was infused with 1.0μg / kg bolus intravenously for 10 minutes, followed by continuous infusion of 0.5μg / (kg · h) and controlled propofol and remifentanil Pressure NS group with 0.9% sodium chloride solution continuous intravenous infusion, the same method and dose and D group. Both groups were aimed at maintaining mean arterial pressure (MAP) at 55-65 mm Hg. The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) of the two groups were recorded before and after induction and depressurization. The intraoperative propofol and Remifentanil dosage; at the same time according to Fromme surgical field score table to assess the quality of surgical field of vision. SPSS11.0 software package for statistical analysis. Results: During the controlled hypotension period, MAP values in both groups were significantly lower than those before induction (P <0.01). The MAP and HR in group D were significantly lower than those in group NS at T3 (beginning of surgery), T4 (15 min after start of surgery) and T5 (30 min after start of surgery) (P <0.05). The HR of NS group was significantly higher than that before induction (P <0.05) at T3, T4, T5 and T6 (60 min after the start of surgery). The dosage of propofol in group D was significantly lower than that in group NS (P <0.05), and the score in group D was significantly better than that in group NS (P <0.05). Conclusion: Dexmedetomidine is effective and safe for oral and maxillofacial surgery in orthognathic surgery. At the same time, it can prevent heart rate and blood pressure fluctuations, stabilize hemodynamics and reduce the dosage of propofol. Field quality more clearly.