右美托咪定在妇科腹腔镜手术中的应用

Application of Dexmedetomidine in Gynaecological Laparoscopy

【目的】探讨右美托咪定对妇科腹腔镜手术患者围术期应用的安全性与有效性。【方法】选择ASAI～Ⅱ级择期全麻下行妇科腹腔镜子宫切除手术的患者40例，随机分为右美托咪定组（D组）和对照组（C组），每组20例。D组在麻醉诱导插管前10min静脉泵注负荷剂量的右美托咪定O．5ug／kg，继以0．5Mg／（kg·h）持续泵注。C组持续泵注等容量的生理盐水。记录入室时（T0）、负荷剂量输注完时（T1）、气管插管时（T。）、气腹建立后5min（T3）、气腹后30min（T4）、解除气腹后5min（Ts）各时间点的平均动脉压（MAP）、心率（HR），并检测T0、T2-5。时点血肾上腺素、去甲肾上腺素水平。记录各组丙泊酚的用量。【结果】与T0比较，T2～5时点C组MAP明显升高，HR明显增快（P〈0．05）D组MAP、HR无明显变化；与To比较，T2～5时点C组肾上腺素和去甲肾上腺素水平明显升高（P〈0．05），与D组相比有显著性差异（P〈0．05）。术中D组患者丙泊酚用量显著少于C组（P〈0．05）。【结论】妇科腹腔镜全麻手术辅助应用右美托咪定能抑制肾上腺素和去甲肾上腺素的释放，减轻麻醉插管及气腹时的应激反应，并能减少丙泊酚的用量。

[Objective]To explore the safety and effectiveness of peroperative dexmedetomidine used in pa- tients undergoing gynaecological laparoscopy. [Methods]Totally 40 patients（ASA I ） undergoing selec- tive laparoscopic hysterectomy under general anesthesia were enrolled in this study. The patients were random- ly divided into dexmedetomidine group（ n = 20, group D） and control group （ n = 20, group C）. Group D re- ceived intravenous pump injection of dexmedetomidine 0.5 ug/kg 10min before intubation of anesthesia induc- tion, and then received continuous injection of dexmedetomidine at a rate of 0.5 ug/（kg · h）, while control group received isovolume normal saline. Mean arterial pressure（MAP） and heart rate（HR） were recorded at entering operation room（T0 ）, at the end of loading dose infusion（T1 ）, intubation（T2 ）, 5min and 30rain after pneumoperitoneum（T3-4） and 5rain after de-pneumoperitoneum（T5 ）. Meanwhile, the levels of adrenaline and norepinephrine at T0-5 in both groups were measured. The dosage of propofol was also recorded. [Results] Compared with TO, MAP and HR in group C obviously increased at T2-5 （ P d0.05）. Compared with TO, the levels of adrenaline and norepinephrine in group C at T2-5 increased obviously（p〈0.05）, and there was signif- icant difference between group C and group D（ P 〈0.05）. The intraoperative dosage of propofol in group D was obviously lower than that in group C（ P d0.05）. [Conclusion] Dexmedetomidine used in laparoscopy un- der general anesthesia can inhibit the release of adrenaline and norepinephrinetion, reduce the stress reaction at anesthesia intubation and CO2 pneumoperitoneum and decrease the dosage of propofol.