右美托咪定复合瑞芬太尼在妇科腹腔镜手术中的应用

The application of dexmedetomidine combined with remifentanil in anesthesia of gynecology laparoscopic operation

目的:观察右美托咪定复合瑞芬太尼用于妇科腹腔镜手术麻醉的可行性。方法:40例行妇科腹腔镜手术患者,ASAI～Ⅱ级,随机分为两组:右美托咪定组(D组)、丙泊酚组(P组),每组20例,D组予微量泵输注右美托咪定1.0μg/kg,设定时间10min输完,输注8min后静脉推注顺苯磺酸阿曲库铵0.15mg/kg,同时微量泵输注瑞芬太尼1.0μg/kg,60秒输完,1分钟后行气管插管。P组予微量泵同时输注丙泊酚2.5mg/kg及瑞芬太尼1.0μg/kg,均60秒输完,输注期间待患者睫毛反射消失后静脉推注顺苯磺酸阿曲库铵0.15mg/kg,1分钟后行气管插管。观察两组患者在麻醉诱导前(T0)、气管插管前(T1)、气管插管即刻(T2)、气管插管后3min(T3)及拔除气管导管前(T4)、拔除气管导管即刻(T5)、拔管后5min(T6)的平均动脉压(MAP)、心率(HR)以及不良反应发生情况。结果:D组患者在T2和T5时点的MAP和HR与T1及T4比较差异无显著性(P>0.05),P组患者在T2和T5时点的MAP和HR与T1及T4比较有显著性差异(P<0.05),组间比较差异有显著性(P<0.05)。P组拔管期躁动、拔管后低氧血症及清醒后伤口疼痛发生率较D组高,组间比较有显著性差异(P<0.05)。结论:右美托咪定复合瑞芬太尼用于妇科腹腔镜手术在整个麻醉诱导、插管、拔管期间血流动力学稳定,术后拔管期躁动及拔管后低氧血症和清醒后伤口疼痛发生率低,可安全应用于临床。

Objective：To observe the feasibility of dexmedetomidine combined with remifentanil in anesthesia of gynecology laparoseopic operation Methods： 40 patients with gynecology laparoseopie operation and ASA I -II grade were selected. They were randomly assigned into dexmedetomidine group（D group） and propofol group（P group） in which each group had 20 patients. Patients in D group were infused dexmedetomidine 1.0g/kg by micro pump within 10 minutes;and after 8 minutes, eisatraeurium 0.15mg/kg was pushed in vein;at the same time,remifentanil 1.Og/kg was infused by m^ero pump within 1 minute; and after 1 minute, patients were proceed tracheal eannula. Patients in P groul~ were infused propofol 2.5 mg/kg and remifentanil 1.0g/kg by micro pump within 1 minute;and in the eouse of infusion,patients were pushed eisatraeurium 0.15mg/kg in abolition of eyeash reflex;and after 1 minute, patients were proceed tracheal eannula. Patients in two groups measured MAP, HR and observed adverse reaction in anterior induction of anesthesia（T0）, anterior progress traebeal eannula（Tl）, progress tracheal cannula（T,_）, 3 minutes subsequenee of progress tracheal eannula（T3）, before extubation（T4）,extraetian of tracheal cannula（T~） and 5 minutes subsequenee of extraction tracheal eannula（T6）. Results： Difference in MAP and HR in D group patients at time of T：, Ts and Ti, T4 was not statistically significant（ P〉0.05 ）. Difference in MAP and HR in P group patients at time of T2,Ts and T1 ,T4 was statistically significant（P〈0.05 ）. In P group, incidence of restlessness, hypoxemia in subsequence of extraction u＇acheal cannula, and wound pain in alertness were statistically significant（P〈0.05 ）. Conclusion： Dexmedetomidine combined with remifentanil in gynecology laparoscopic operation patients has hemodynamic stability in induction of anesthesia, progress tracheal cannula and extraction of tracheal cannula. Incidence of restlessness, hypoxemia and wound pain in alertness in patients are low.