右美托咪啶用于门诊宫腔镜手术的有效性及安全性

The efficacy and safety of dexmedetomidine for hysteroscopy in outpatient department

目的:观察右美托咪啶(dexmedetomidine,Dex)用于门诊宫腔镜(hysteroscopy)手术麻醉的有效性及安全性。方法:ASA I级宫腔镜手术患者60例,随机分为:Dex 0.2μg/kg组(D1组)、0.3μg/kg组(D2组)和0.9%氯化钠溶液对照组(C组),每组20例。D1、D2组于术前10 min静脉注射Dex(推注时间1 min),C组以同样方式注射0.9%氯化钠溶液。三组患者均静脉注射舒芬太尼(0.1μg/kg)后,开始静脉靶控输注丙泊酚(血浆靶浓度3.0μg/mL),直至手术结束。观察注射Dex前(T0)、靶控异丙酚前(T1)、睫毛反射消失(T2)、扩宫颈(T3)、术中(T4)、停用靶控(T5)、苏醒时(T6)各时点的氧饱和度(SpO2)、心率(HR)、平均动脉压(MAP)变化,记录麻醉起效时间、苏醒时间、体动、呼吸抑制和恶心呕吐等不良反应及患者满意程度。结果:与T0比较,D1、D2组各时点HR明显下降(P<0.01),C组在T2～T6时点HR明显下降(P<0.01);与T0比较,三组(除T1外)其余各时点MAP明显下降(P<0.01或P<0.05);与C组比较,D1组在T1、T5时HR下降(P<0.05),D2组在T1、T3、T4和T5时HR明显下降(P<0.01或P<0.05);D1、D2组麻醉起效时间明显短于C组(P<0.01),D1、D2组苏醒时间比C组要长(P<0.05),D1、D2组麻醉起效与苏醒时间相比差异无统计学意义(P>0.05);术中体动D2比C组少(P<0.05);D1、D2组宫缩痛发生率均较C组低(P<0.05)。结论:小剂量单次静脉注射Dex用于宫腔镜手术能缓解术前患者的紧张情绪,加快麻醉起效时间及减少术后宫缩痛的发生率,效果良好,安全可靠。

Objective： To observe the efficacy and safety of dexmedetomidine （Dex） foranesthesia of hysteroscopy in outpatient department. Methods： Sixty patients undergoing hysteroscopic surgery, in a double-blind, randomized controlled manner, were randomly di- vided into three groups, Dex 0.2 μg/kg group（Dl group）, Dex 0.3 μg/kg group （D2 group） and control group （C group）, 10 minutes before surgery, DI, D2 group intravenous injection with Dex （bolus 1 min）, C group injection with normal saline. Three groups of patients were intravenous sufentanil （0.1μg/kg）, then propofol target-controlled infusion at 3.0 μg/mL, until the end of surgery. Non-invasive hemodynamic （SpO2, HR, MAP） before injection Dex （T0）, before propofol target-controlled infusion （T1）, eyelash reflex （T2）, cervical extension （T3）, surgery （T4）, disable the target control （T5）, recovery （T6） were observed, record the onset and recovery of anesthesia, body movement, respiratory depression, nausea, vomiting, other side effects and patient satisfaction. Results： Compared with T0, D1, D2 group HR decreased significantly at each time point （P〈0.01）, C group HR decreased significantly in the T2-T6（P 〈0.01）; compared with To, the three groups （except for T1） MAP decreased significantly at each time point （P〈O.OI or F〈0.05）; compared with C group, HR of D1 group decreased at T1 and T5 （P〈0.05）, HR of D2 group decreased at T1, T3, T4 and T5; DI, D2 group onset of anesthesia was significantly shorter than the C group （P〈0.01）, and recovery is longer than the C group （P 〈0.05）, there was no significant difference of onset and recovery of anesthesia between DI, D2 group （P〉0.05）; body movement of D2 group was less than the group C （F〈0.05）; D1,D2 group, the pain of uterine contraction had lower incidence rate than the group C（P〈0.05）. Conclusion：Before surgery, low-dose single intravenous Dex for patients of hysteroscopic can relieve anxiety before the operation, accelerate the onset of anesthesia and reduce postoperative pain of uterine contraction. Dex for anesthesia of hysteroscopy in outpatient department is effective and safe.