右美托咪定联合过度通气在不损害脑氧合的情况下改善内镜鼻窦手术中的术野可见度
Dexmedetomidine Added to Hyperventilation Improves Surgical Field Visibility Without Compromising Cerebral Oxygenation During Endoscopic Sinus Surgery.
文献信息
| PMID | 42924419 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yuanyuan Lin |
| 作者单位 | The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China. |
| 期刊 | International forum of allergy & rhinology |
| SCI 分区 | Q1 |
| IF | 4.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 在内镜鼻窦手术（ESS）中，最佳的术野可见度至关重要，然而减少出血的策略可能引发对脑氧合受损的担忧。我们评估了在过度通气基础上加用右美托咪定是否能改善ESS期间的术野可见度而不损害脑氧合。
方法： 在这项双盲随机对照试验中，74例接受ESS的慢性鼻窦炎患者被随机分配接受右美托咪定联合过度通气或单纯过度通气。主要终点为手术开始后30分钟评估的Boezaart术野评分。次要终点为术中脑氧饱和度（ScO2）、出血速率、血流动力学变量、麻醉药用量及术后恢复结局。
结果： 与单纯过度通气相比，右美托咪定联合过度通气改善了术野可见度，手术开始后30分钟Boezaart评分更低（2.0（1.0-2.0）对3.0（2.0-3.0），p = 0.003）。纵向分析进一步表明，右美托咪定联合过度通气与随时间推移术野评分较差的几率降低相关（OR = 0.180，95% CI，0.062-0.524；p = 0.002）。右美托咪定联合过度通气组的出血速率更低，而术中ScO2在两组间相当，且未发生脑去饱和事件。
结论： 在接受ESS的患者中，在过度通气基础上加用右美托咪定改善了术野可见度而不损害术中脑氧合。这一联合策略可能有助于优化ESS的手术条件。
英文摘要
BACKGROUND: Optimal surgical field visibility is essential during endoscopic sinus surgery (ESS), yet strategies that reduce bleeding may raise concern about impaired cerebral oxygenation. We evaluated whether adding dexmedetomidine to hyperventilation improves surgical field visibility during ESS without compromising cerebral oxygenation.
METHODS: In this double-blinded randomized controlled trial, 74 patients with chronic rhinosinusitis undergoing ESS were randomly assigned to receive dexmedetomidine plus hyperventilation or hyperventilation alone. The primary endpoint was the Boezaart surgical field score assessed 30 min after the start of surgery. Secondary endpoints were intraoperative cerebral oxygen saturation (ScO2), bleeding rate, hemodynamic variables, anesthetic consumption, and postoperative recovery outcomes.
RESULTS: Compared with hyperventilation alone, dexmedetomidine plus hyperventilation improved surgical field visibility, with a lower Boezaart score at 30 min after surgery onset (2.0 (1.0-2.0) vs. 3.0 (2.0-3.0), p = 0.003). Longitudinal analysis further demonstrated that dexmedetomidine plus hyperventilation was associated with lower odds of poorer surgical field scores over time (OR = 0.180, 95% CI, 0.062-0.524; p = 0.002). The bleeding rate was lower with dexmedetomidine plus hyperventilation, whereas intraoperative ScO2 was comparable between groups and no cerebral desaturation events occurred.
CONCLUSIONS: In patients undergoing ESS, adding dexmedetomidine to hyperventilation improved surgical field visibility without compromising intraoperative cerebral oxygenation. This combined strategy may help optimize operative conditions in ESS.