右美托咪定-氯胺酮静脉复合麻醉在宫颈锥切术中的临床应用

Clinical application of dexmedetomidine-ketamine balanced intravenous anesthesia in cervical conization

目的探讨右美托咪定复合氯胺酮用于宫颈锥切手术的临床效果及安全性。方法选择ASAⅠ～Ⅱ级拟行宫颈锥切手术患者60例,随机分为右美托咪定-氯胺酮组(D-K组)和丙泊酚-舒芬太尼组(PS组),每组30例。D-K组给予右美托咪定(负荷量1μg·kg^(-1),继以1.5μg·kg^(-1)·h^(-1)持续泵注)和氯胺酮(负荷量0.5 mg·kg^(-1),继以1 mg·kg^(-1)·h^(-1)持续泵注)静脉复合麻醉, P-S组给予靶控输注丙泊酚(起始靶浓度3 mg·L^(-1))和静脉注射舒芬太尼0.15μg·kg^(-1)复合麻醉。观察并记录警觉与镇静评分、脑电双频指数、脉搏血氧饱和度(SpO_2)等指标,记录麻醉诱导时间、定向力恢复时间、不良反应情况和术后6 h视觉模拟量表(VAS)评分,术后调查手术者和患者满意度。结果 D-K组患者术中呼吸维持稳定, SpO_2均在98%以上,呼气末二氧化碳分压(P_(ET)CO_2)维持在35～45 mm Hg,无呼吸抑制发生; P-S组术前SpO_2低于D-K组,术中P_(ET)CO_2高于D-K组(P <0.05),呼吸抑制发生率80%(24/30),高于D-K组(P <0.05)。D-K组术后6 h VAS评分低于P-S组(P <0.05),麻醉诱导时间和定向力恢复时间长于P-S组(P <0.05)。低血压发生率P-S组为70%(21/30), D-K组为3%(1/30),组间差异显著(P <0.05)。两组手术时间、患者及手术者对麻醉效果的满意率无显著差异(P> 0.05)。结论右美托咪定-氯胺酮复合可安全用于宫颈锥切手术麻醉,患者术中血流动力学平稳,自主呼吸维持良好。

AIM To investigate the clinical efficacy and safety of dexmedetomidine combination with ketamine for cervical conization. METHODS A total of 60 ASA grade Ⅰ-Ⅱ patients who received cervical conization were selected and randomly divided into dexmedetomidine-ketamine group (D-K group, n = 30)and propofol-sufentanil group (P-S group, n = 30). The D-K group was given dexmedetomidine (a bolus of 1 μg·kg^-1, followed by 1.5 μg·kg^-1·h^-1 infusion during the operation) and ketamine (a bolus of 0.5 mg·kg^-1,followed by 1 mg·kg^-1·h^-1infusion during the operation). In the P-S group, target-controlled infusion of propofol (the target plasma concentration was set at 3 mg·L-1) and sufentanil 0.15 μg·kg^-1was given. The observer’s assessment of alertness/sedation scale, bispectral index and pulse oxygen saturation (SpO2) were observed and recorded. The anesthesia induction time, orientation recovery time, adverse reactions and postoperative 6 h visual analogue scale (VAS) score, and postoperative satisfactory degree of both operators and patients were all required to be observed and recorded. RESULTS In the D-K group, the patients maintained a stable intra-operative breathing, with SpO2 maintaining above 98%, and end-tidal carbon dioxide partial pressure (PETCO2) was kept at 35-45 mmHg without respiratory depression. In the P-S group, SpO2 was lower than that in the D-K group before the operation, and the PETCO2 was higher than that in the D-K group during the operation (P <0.05). The incidence rate of respiratory depression was 80% (24/30) in the P-S group, and higher than that in the D-K group (P < 0.05). In the D-K group, the postoperative 6 h VAS score was lower than that in the P-S group (P < 0.05), and the anesthesia induction time and orientation recovery time were longer than those in the P-S group (P < 0.05). The incidence rate of hypotension was 70% (21/30) in the P-S group and 3% (1/30)in the D-K group, and there was a significant difference (P < 0.05). There was no significant difference in operative time, and the satisfaction rate of both patients and operators between the two groups (P > 0.05).CONCLUSION Dexmedetomidine-ketamine can be safely used for anesthesia of cervical conization. The hemodynamics is stable during surgery with a well-maintained spontaneous breathing.