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目的探讨右美托咪定联合地佐辛对口腔颌面肿瘤根治胸大肌皮瓣移植术后有创气道管理患者镇静镇痛效果。方法将口腔颌面肿瘤根治胸大肌皮瓣移植术后有创气道管理60例按照随机原则分为右美托咪定组(DE组,20例)、右美托咪定联合地佐辛组(DED组,20例)和等剂量0.9%氯化钠注射液组(C组,20例)。DE组经静脉泵入负荷剂量的右美托咪定0.5μg/kg,10min输注完毕,然后以0.6μg/(kg·h)维持;DED组经静脉泵入负荷剂量的右美托咪定0.5μg/kg,10 min内输注完毕,然后以0.4μg/(kg·h)及地佐辛10μg/(kg·h)同时维持;C组给予同等剂量0.9%氯化钠注射液输注。记录三组患者术前一般情况,观察不同时间心率(HR)、平均动脉压(MAP)、呼气末二氧化碳分压(PetCO2)和Ramsay镇静评分标准评分,并在T4时采用视觉模拟法(VAS)评估疼痛情况。结果三组一般情况及不同时间PetCO2比较差异无统计学意义(P>0.05)。在T2~T4时,DE组和DED组的HR和MAP显著低于C组(P<0.05);在T2时,DE组MAP显著低于DED组(P<0.05);在T2和T3时,DE组的HR显著低于DED组(P<0.05)。在T2~T3时,DE组和DED组的Ramsay评分显著高于C组(P<0.05),DED组的Ramsay评分也显著高于DE组(P<0.05);在T4时,DE组和DED组的VAS评分显著低于C组(P<0.05),DED组的VAS评分也显著低于DE组(P<0.05)。结论右美托咪定联合地佐辛静脉输注用于口腔颌面肿瘤根治胸大肌皮瓣移植术有创气道管理患者镇静安全、镇痛有效,且能减少右美托咪定用量,减轻其不良反应。
Objective To investigate the sedative and analgesic effects of dexmedetomidine combined with dezocine on patients with traumatized pectoralis major myocutaneous flap after oral and maxillofacial neoplasms. Methods Sixty cases of traumatic maxillofacial flap transplantation after oral and maxillofacial tumor implantation were divided into two groups according to randomization: demetimidime group (DE group, 20 cases), dexmedetomidine and dezocine (DED group, 20 cases) and 0.9% sodium chloride injection group (C group, 20 cases). The patients in DE group were injected intravenously with dexmedetomidine at a loading dose of 0.5 μg / kg, and the infusion was completed at 10 minutes and then maintained at 0.6 μg / (kg · h). The DED group was intravenously infused with dexmedetomidine 0.5μg / kg, 10min infusion completed, and then 0.4μg / (kg · h) and dezocine 10μg / (kg · h) while maintaining the same dose of 0.9% sodium chloride injection group C infusion . The general conditions of the three groups were recorded and the heart rate (HR), mean arterial pressure (MAP), end-tidal carbon dioxide (PetCO2) and Ramsay sedation score were scored at different time points and visual analogue (VAS Evaluate the pain situation. Results There were no significant differences in PetCO2 between the three groups and at different time points (P> 0.05). At T2 ~ T4, HR and MAP in DE group and DED group were significantly lower than those in C group (P <0.05); at T2, MAP in DE group was significantly lower than that in DED group (P <0.05); at T2 and T3, HR in DE group was significantly lower than that in DED group (P <0.05). The Ramsay scores of DE group and DED group were significantly higher than those of C group (P <0.05) at T2 ~ T3 and Ramsay scores of DED group were significantly higher than that of DE group (P <0.05) Group VAS score was significantly lower than the C group (P <0.05), DED group VAS score was significantly lower than the DE group (P <0.05). Conclusion Dexmedetomidine combined with dezocine intravenous infusion for oral and maxillofacial tumor radical corticosteroid flap transplantation in patients with traumatic airway management is safe, analgesic effective, and can reduce the amount of dexmedetomidine, Reduce its adverse reactions.