右美托咪啶对不孕患者全麻术后焦虑状态的影响

Effects of dexmedetomidine on anxiety in infertile patients after general anesthesia

目的:探讨右美托咪啶对不孕症患者全麻术后焦虑的影响。方法:选择在本院生殖医学中心行腹腔镜手术的不孕症患者90例,以随机数字表法将患者随机分为3组,每组30例。患者术前进行焦虑评估。A组为对照组,B组为右美托咪啶组麻醉诱导后给予右美托咪啶0.2μg·kg-1,10 min静脉泵入。C组为右美托咪啶组麻醉诱导后给予右美托咪啶0.4μg·kg-1,10 min静脉泵入。记录循环指标、脑电双频谱指数(BIS)、手术时间、拔管时间,患者离开麻醉恢复室时对其焦虑状态再次评估。采用视觉模拟评分法(VAS)评估术后2,4,12,24 h的疼痛程度,并记录恶心、呕吐、寒战情况及加用镇痛药物情况。结果:不孕症患者术前明显焦虑,C组患者在离开麻醉恢复室时焦虑反应最轻,哭泣、颤抖、出汗和呼吸急促出现的例数最少(P<0.05)。B组和C组术中和手术结束时的BIS值低于对照组A组(P<0.05)。C组患者拔管时间长于A组(P<0.05),恶心、呕吐和寒战的发生例数少于A组(P<0.05)。B组和C组患者术后使用镇痛药物的例数少于A组(P<0.05)。C组患者术后2,4,12,24 h VAS评分低于A组(P<0.05),B组患者术后2,4 h VAS评分低于A组(P<0.05)。结论:不孕症患者术前存在不同程度焦虑状态,围麻醉期辅助使用右美托咪啶可以减轻术后疼痛,降低恶心、呕吐、寒战的发生率,减少术后镇痛药物的使用量,以右美托咪啶0.4μg·kg-1静脉用药组获得较满意的麻醉效果。

Objective：To investigate the effect of dexmedetomidine on anxiety in infertile patients after general anesthesia.Methods：Ninety infertile patients were selected for laparoscopic surgeries in the reproductive medicine center in our hospital.The patients were randomly divided into 3 groups（30 patients in each group）.Patients＇ anxiety states were evaluated by themselves using STAI form and by one physician before operation.Patients were intravenously given with dexmedetomidine 0.2 or 0.4 μg·kg- 1 within 10 min with an infusing pump after anesthesia induction.Bispectral index during anesthesia,operation duration and extubation time were recorded.Before the patients leave PACU,their anxiety status was objectively evaluated again by the same physician.The intensity of pain was evaluated using VAS score（0 - 10,0 = no pain,10 = worst pain） at 2,4,12 and 24 h after operation.The adverse effects,such as nausea,vomit and shivering,were recorded and compared.Results：The level of anxiety was high in infertile patients before operation.The level of anxiety in patients treated with dexmedetomidine 0.4 μg·kg- 1 was the least before leaving PACU.In this group,the number of patients who had sob,shivering,sweatiness and trembling was the least（P〈0.05）.BIS during operation and at the end of operation was lower in patients treated with dexmedetomidine 0.2 and 0.4 μg·kg- 1 than that of control group（P〈0.05）.The extubation time of 0.4 μg·kg- 1 group was longer than that of control group（P〈0.05）.The numbers of nausea,vomit and shivering in dexmedetomidine 0.4 μg·kg^- 1 group were lower than that in control group（P〈0.05）.The needs of postoperative analgesic drugs were significantly reduced in dexmedetomidine 0.2 and 0.4 μg·kg- 1 groups than that of control group（P〈0.05）.The VAS scores of dexmedetomidine 0.4 μg·kg^- 1 group at 2,4,12 and 24 h after operation were lower than that in control group（P〈0.05）;while at 2 and 4 h,it was lower in dexmedetomidine 0.2 μg·kg- 1 group than that in control group（P〈0.05）.Conclusion：Infertile patients possess high level of anxiety before operation.Intravenous dexmedetomidine can strengthen the effects of analgesic and sedation drugs,reduce the postoperative pain,and reduce the adverse effects and spare the dosage of postoperative analgesic drugs.Intravenous dexmedetomidine 0.4 μg·kg^- 1 given within 10 min while having laparoscopic surgeries can acquire satisfied anesthesia effects in infertile patients.