右美托咪定对妇科腹腔镜手术患者麻醉恢复的影响

Effect of dexmedetomidine on anesthesia recovery in gynecological laparoscopic operation

目的探讨右美托咪定对妇科腹腔镜手术患者麻醉恢复的影响作用。方法 60例行妇科腹腔镜手术患者,ASAⅠ～Ⅱ级,随机分为两组:美托咪定组(A组)和生理盐水对照组(B组),每组30例。A组患者于气管插管后手术开始前给予0.5μg/kg右美托咪定泵注10min,B组患者给予相同剂量生理盐水。记录各组给药前(T1)、拔管时(T2)及拔管后5min(T3)、10min(T4)、15min(T5)动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、麻醉趋势指数(NI)、Ramsay镇静评分,记录患者停药至清醒睁眼时间、拔出喉罩时间;记录拔管后苏醒期内患者呼吸抑制、术后烦躁及恶心呕吐等不良反应的情况。结果两组患者拔管时间、清醒时间比较差异无统计学意义(P>0.05);A组T2时点MAP、HR明显高于T1,T3～T5时点MAP、HR低于T1;A组T3～T5时点MAP、HR明显高于对照组B组,NI、Ramsay评分优于B组,且呼吸抑制、术后烦躁及恶心呕吐等不良反应明显低于B组。结论右美托咪定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,且不影响苏醒期呼吸、意识恢复和拔管条件,可安全应用于临床。

Objective To investigate the effect of dexmedetomidine on anesthesia recovery in gynecological laparo- scopic operation. Methods Sixty cases of patients underwent gynecological laparoscopic operation with ASA Ⅰ-Ⅱ were randomly divided into two groups： dexmedetomidine group （group A） and normal saline control group （group B） with 30 eases in each group. Patients in group A were given 0.5 μg/kg dexmedetomidine infusion for 10 min after tra- cheal intubation but before operation. Patients in group B were given the same dose of normal saline. The mean arteri-l pressure （MAP）, heart rate （HR）, saturation of pulse oximetry （SpO2）, narcotrend index （NI） and ramsay sedation score in each group were recorded before administration （T1）, at the time of extubation （T2）, 5 rain （T3）, 10 rain （T4） and 15 min （T5） after extubation. The time until drug withdrawal to consciousness and the time of pulling out laryngeal mask airway were recorded. And the adverse effects during recovery period after extubation were also recorded, such as respiratory depression, postoperative irritability, nausea and vomit. Results There was no significant difference be- tween the two groups in extubation time and consciousness time （P 〉 0.05）. In group A, the MAP and HR at T2 was significantly higher than that at T1, and that at T3-T5 was lower than that at T1. The MAP and HR at T3-T5 in group A was significantly higher than that in group B, NI and Ramsay score in group A was better than that in group B. And respiratory depression, postoperative irritability, nausea and vomit, and other adverse reactions in group A were sig- nificantly lower than that in group B. Conclusion Dexmedetomidine used in gynecological laparoscopic operation can stabilize haemodynamics during the period of induction of anesthesia, intubation and extubation. And it does not influ- ence the breath, consciousness recovery and extubation condition in recovery period. So it can be safely applied in clinic.