右美托咪定用于妇科手术的镇静观察

Curative Effect Observation of Different Doses of Dexmedetomidine for Sedation in Gynecology Surgery

目的：观察不同维持剂量的右美托咪定用于妇科手术的镇静效果。方法：选择硬膜外联合腰麻下行妇科手术的患者60例，采用随机数字表法分为A、B两组各30例。麻醉成功后两组均予负荷剂量右美托咪定0．9μg／kg静脉泵注10rain后，再分别给予0．4μg／（kg·h）（A组）和0．5μg／（kg·h）（B组）维持，且在切皮前给予地佐辛0．1mg／kg静注。观察人室后5min基础值（T0）、腰麻成功平卧时口，）、右美托咪定负荷量泵完时（T2）、手术后半小时（T3）及术毕（T4）各时点的HR、MAP、SpO2和L、T3时Ramsay评分，同时观察术中的牵拉反应。结果：两组患者各时点MAP、Sp02值与本组T0比较，差异均无统计学意义（P〉O．05）；两组患者R、B时点的HR与本组T0比较，均明显降低（P〈O．05），但T3时点HR与T2时点比较，差异无统计学意义（P〉0．05）。组间比较，两组患者各时点MAP、Sp02、HR比较，差异无统计学意义（P〉0．05）。A组T2、L时点有8例Ramsay评分为1分，其中6例因牵拉反应表现烦躁，B组均为2～4分，仅2例有轻度胃部不适（P〈0．05）。结论：在妇科手术中，用右美托咪定0．9μg／kg负荷量静脉泵注10min后，再以0．5pμkg·h）维持，能有效减少牵拉反应，提供更安全有效的镇静深度。

Objective： To observe the efficacy of different maintenance doses of dexmedetomidine for sedation in gynecology surgery.Method： 60 patients which were scheduled for gynecology surgery with combined spinal-epidural anesthesia（CSEA） were randomly divided into two groups, 30 cases in each group.After the anesthesia, both groups were given loading dosage of 0.9· g/kg of dexmedetomidine by continuous pump-infusion for 10 minutes, then maintained with it by intravenous pumping at the rate of 0.4 μg/（kg · h）（Group A）or 0.5 μ g/（kg · h）（Group B）.Both groups were injected dezocine 0.1 mg/kg before the skin was cut.HR, MAP, SpOz were recorded at 5 minutes after entering the operating room（base value）（T0）, after CSEA（T1）, after infusing the loading dose of dexmedetomidine （T2）, half an hour after the operation（T3）, and after operation（T4）.The traction reaction during operation and the Ramsay scores at T2, T3 were also observed. Result： Compared with To, there were no significant differences about MAP and SpO2 at T1, T2, T3, T4 in both groups（P〉0.05）.HR at T2, T3 of both groups were obviously lower than those at T0（P〈O.05）, but compared with T2, there were no significant differences about HR at T3 in both groups（P〉0.05）.There were no significant differences about MAP, Sp02 and HR at T0, Tt, T2, T3, T4 between the two groups（P〉0.05）.8 patients achieved 1 score in group A about Ramsay, of which 6 cases were restless because of the traction reaction.All patients achieved 2-4 scores in group B about Ramsay, of which only 2 cases complained for stomach discomfort（P〈0.05）.Conclusion： Dexmedetomidine intravenous infusion 0.9 μ g/kg followed by 0.5 μ g/（kg · h） can effectively reduce the traction reaction and provide safer and more effective depth of sedation during gynecology.