文章摘要
瑞芬太尼联合右美托咪定用药时机对鼻窦手术术野质量的影响
Effect of the timing of remifentanil combined with dexmedetomidine on surgical field quality in sinus surgery
  
DOI：10.12089/jca.2026.06.007
中文关键词: 慢性鼻-鼻窦炎  功能性内镜鼻窦手术  瑞芬太尼  右美托咪定  Boezaart术野评分
英文关键词: Chronic rhinosinusitis  Functional endoscopic sinus surgery  Remifentanil  Dexmedetomidine  Boezaart score
基金项目:国家自然科学基金面上项目（81871597）；广东省自然科学基金面上项目（2016A030313232）
作者单位E-mail
林晓瑜 510630,广州市,中山大学附属第三医院麻醉科  
冉涛嘉 510630,广州市,中山大学附属第三医院麻醉科  
徐今言 510630,广州市,中山大学附属第三医院麻醉科  
原冬冬 510630,广州市,中山大学附属第三医院麻醉科  
黄品婕 510630,广州市,中山大学附属第三医院麻醉科 hpjie@126.com 
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中文摘要:
      
目的：比较麻醉诱导前与鼻内镜进入鼻腔前联合使用右美托咪定和瑞芬太尼对功能性内镜鼻窦手术（FESS）术野质量及血流动力学的影响。
方法：选择行FESS患者，年龄18～60岁，ASA Ⅰ或Ⅱ级。采用随机数表法将患者分为两组：诱导前用药组（BI组）和鼻内镜进入鼻腔前用药组（BO组）。两组患者均采用静脉诱导联合静-吸复合麻醉，BI组和BO组分别在麻醉诱导前10 min和鼻内镜进入鼻腔前10 min泵注右美托咪定0.5 μg·kg·-1h-1联合瑞芬太尼0.05 μg·kg·-1min-1。主要指标为平均Boezaart评分>2分比例。次要指标包括Boezaart评分最大值>2分比例、估计出血量、估计出血速率，基线时、插管时、插管后5 min、进镜时和进镜后30 min的SBP。
结果：共纳入患者63例，BI组32例，BO组31例。与BO组比较，BI组平均Boezaart评分>2分比例明显下降［4例（12.5%）vs. 14例（54.8%）， P< 0.05］，Boezaart评分最大值> 2分比例明显下降，估计出血量明显减少，估计出血速率明显下降，插管时、进镜时、进镜后30 min SBP明显降低（P<0.05）。
结论： 与鼻内镜进入鼻腔前用药相比，麻醉诱导前联合使用右美托咪定和瑞芬太尼能减少术野出血，减少术中血流动力学的不良波动，为FESS提供更加良好的术野条件。
英文摘要:
      
Objective: To compare the effects of combined administration of dexmedetomidine and remifentanil before induction versus before nasal endoscope insertion on surgical field bleeding and intraoperative hemodynamics in functional endoscopic sinus surgery (FESS).
Methods: Patients aged 18-60 years, ASA physical grade Ⅰ or Ⅱ, scheduled for FESS were randomly divided into two groups: the pre-induction group (group BI) and the pre-endoscope insertion group (group BO). Both groups received intravenous induction combined with intravenous-inhalational balanced anesthesia. Group BI received a pump infusion of dexmedetomidine 0.5 μg·kg·-1h-1 plus remifentanil 0.05 μg·kg·-1min-1 starting 10 minutes before anesthesia induction, while the group BO received the same infusion starting 10 minutes before nasal endoscope insertion. The primary outcome was the proportion of patients with a mean Boezaart score > 2. Secondary outcomes included the proportion of patients with a maximum Boezaart score > 2, estimated blood loss, estimated bleeding rate, SBP at baseline, during intubation, 5 minutes after intubation, when the nasal endoscope entered the nasal cavity, and 30 minutes after the nasal endoscope entered the nasal cavity.
Results: A total of 63 patients were enrolled, 32 patients in group BI, 31 patients in group BO. Compared with group BO, group BI had a significantly lower proportion of patients with a mean Boezaart score > 2 [4(12.5%)vs. 14(54.8%), P < 0.05], a significantly lower proportion with a maximum Boezaart score > 2, significantly lower estimated blood loss, and significantly lower bleeding rate, group BI had significantly lower SBP at the time of intubation, nasal endoscope entry into the nasal cavity, 30 minutes after nasal endoscope entry, and during nasal packing (P < 0.05).
Conclusion: Compared with administration before nasal endoscope insertion, pre-induction combined use of remifentanil and dexmedetomidine reduces surgical field bleeding and attenuates intraoperative hemodynamic fluctuations, providing better surgical field conditions for functional endoscopic sinus surgery.
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