右美托咪定复合丙泊酚在宫颈锥切手术麻醉中的应用

Feasibility of using dexmedetomidine combined with propofol for conization of cervix

目的探讨右美托咪定(Dex)复合丙泊酚用于宫颈锥切手术麻醉的可行性。方法择期行宫颈锥切术患者75例,ASAⅠ级或Ⅱ级,随机分为3组,每组25例。对照组(C组)、小剂量Dex组(D_1组)、大剂量Dex组(D_2组)于手术开始前15 min分别以微量泵缓慢输注氯化钠注射液10 mL、Dex 0.4μg·kg^(-1)、Dex 0.8μg·kg^(-1),继之启动靶控输注丙泊酚,术中根据患者反应和脑电双频指数(BIS)的变化调整丙泊酚靶浓度,维持合适的麻醉深度,并根据需要注射小剂量芬太尼。记录入室、局麻时、手术开始、术中10 min、术中20 min、术毕以及清醒时的呼吸和血流动力学参数、不良反应发生情况和苏醒时间。结果 3组手术时间、苏醒时间无显著差异(P>0.05)。D_2组丙泊酚c_e(1.5±0.4)mg·L^(-1)、丙泊酚总量(184±54)mg、芬太尼用量(28±11)μg,均显著低于C组[(2.2±0.3)mg·L^(-1)、(259±59)mg、(75±21)μg,P<0.01]和D_1组[(2.0±0.4)mg·L^(-1)、(234±41)mg、(42±16)μg,P<0.01],D_1组芬太尼用量也低于C组(P<0.05)。D_2组脉搏血氧饱和度维持满意,C组和D_1组部分患者出现呼吸抑制,分别有14、4例需要放置通气道或辅助呼吸。C组发生低血压10例,高于D_1组(5例)和D2组(2例),差异非常显著(P<0.01)。而D_2组发生心动过缓12例,高于C组(2例)和D_1组(7例),有显著差异(P<0.05)。结论宫颈锥切手术麻醉中复合应用Dex不仅可减少丙泊酚和芬太尼用量,而且能维持更加稳定的血流动力学和呼吸功能。

AIM To investigate the feasibility of using dexmedetomidine （Dex） combined with propofol for conization of cervix. METHODS Seventy-five ASA I or II patients undergoing conization of cervix were randomly divided into three groups （n = 25 each） ： control group （group C）, low-dose Dex group （group D,）, high-dose Dex group （group D2）. The patients of the three groups were infused with 10 mL sodium chloride injection, Dex 0.4 mg kg-1, Dex 0.8 mg kg-1 slowly by micro pump 15 min before surgery. Then, all the patients were target controlled infused with propofol. The target concentration of propofol was adjusted according to the reaction of patients and the diversification of bispectral index （BIS） to maintain the appropriate depth of anesthesia. The patients were infused low-dose fentanyl when it is necessary. Index of respiration and circulation, adverse reaction and recovery time were recorded. The time points of recording were into the operating room, local anesthesia, beginning of operation, 10 and 20 min during surgery, at the end of operation and patients regained consciousness. RESULTS There was no significant difference in duration of surgery, emergence time among the three groups （P 〉 0.05）. The co of propofol, dose of propofol and fentanyl of group D2 （（1.5 ± 0.4） mgL-1, （184 ± 54） mg, （28 ± 11） μg） were significantly lower than those of the group C （（2.2±0.3） mg-L-1, （259±59） mg, （75±21） μg, P〈0.01） andgroupD1 （（2.0±0.4） mg L-1, （234± 41） mg, （42 ±16） μg, P 〈 0.01）. Dose of fentanyl in the group D1 was lower than that in the group C （P 〈 0.05）. The pulse oxygen saturation of group D2 were maintained better, but many patients of group C and group D1 appeared respiratory depression. There were 14 and 4 patients who needed oropharynx parichnos or assisted ventilation in the group C and group D1, respectively. The incidence rate of hypotension was more higher in the group C than that in the group D1 and group D2 （10 patients vs. 5 patients and 2 patients, P 〈 0.01 ）. Otherwise, the incidence rate of bradycardia was more higher in the group D2 than that in the group C and group D1 （12 patients vs. 2 patients and 7 patients, P 〈 0.05）. CONCLUSION Using Dex combined with propofol not only decreases dose of propofol and fentanyl, but also maintaines indexes of respiration and circulation more stabilizible in conization of cervix.