右美托咪定复合丙泊酚在宫腔镜电切中的镇痛效果观察

Analgesic effect observation of dexmedetomidine combined with propofol in hysteroscopic electric resection

目的观察右美托咪定复合丙泊酚在宫腔镜电切中的镇痛效果及不良反应。方法选择拟行宫腔镜电切患者50例,年龄24~56岁,随机分为两组,D组泵注右美托咪定配置浓度4μg/ml,负荷剂量为1.0μg/kg,持续10 min,复合丙泊酚1~1.5 mg/kg,然后以0.5μg/（kg·h）丙泊酚2~4 mg/（kg·h）维持。P组静注丙泊酚2 mg/kg,后泵注丙泊酚3~6 mg/（kg·h）维持,必要时追加丙泊酚0.2 mg/kg。观察并记录麻醉前（T1）、麻醉后3 min（T2）、扩宫颈时（T3）、手术10 min（T4）、手术20 min（T5）和术毕（T6）的MAP、HR和VAS评分及恶心呕吐、烦躁等不良反应。结果D组苏醒时间短于P组,丙泊酚用量少于P组,术中Sp O2〈90%的患者发生率低于P组（P〈0.05）。D组T2、T3、T4、T5、T6各时点的MAP均低于P组（P〈0.05）,T3、T4、T5、T6各时点的HR均慢于P组（P〈0.05）。D组T3、T4、T5、T6各时点的VAS评分均低于P组（P〈0.05）,烦躁发生率低于P组（P〈0.05）,两组恶心呕吐发生率比较差异无统计学意义（P〉0.05）。结论右美托咪定复合丙泊酚可安全应用于宫腔镜电切。

Objective To observe analgesic effect and adverse reaction of dexmedetomidine combined with propofol in hysteroscopic electric resection. Methods 50 patients（age from 24 to 56 years）underwent hysteroscopic electric resection were selected and randomly divided into two groups.Dexmedetomidine infusion with configuration concentration4 μg/ml,a loading dose of 1.0 μg/kg,continued 10 min,combined with propofol 1-1.5 mg/kg,then 0.5 μg/（kg·h）propofol2-4 mg/（kg·h）maintained in group D.Intravenous propofol 2 mg/kg,after infusion of propofol 3-6 mg/（kg·h）to maintain,if necessary,additional propofol 0.2 mg/kg in group P.MAP,HR,VAS score at before anesthesia（T1）,after anesthesia of3 min（T2）,expanding the cervix（T3）,after surgery of 10 min（T4）,after surgery of 20 min（T5）and the end time of surgery（T6）,adverse reactions with nausea,vomiting and irritability were observed and recorded. Results Recovery time of group D was shorter than that of group P,the amount of propofol in group D was less than that in group P,the incidence rate of Sp O2〈90% in group D was lower than that in group P（P〈0.05）.At T2,T3,T4,T5,T6,MAP of group D was lower than that of group P respectively（P〈0.05）.At T3,T4,T5,T6,HR of group D was slower than that of group P respectively（P〈0.05）.At T3,T4,T5,T6,VAS score of group D was lower than that of group P respectively（P 〈0.05）.The incidence rate of irritability in group D was lower than that in group P（P〈0.05）.The incidence rate of nausea,vomiting in two groups was compared,with no statistical difference（P〉0.05）. Conclusion Dexmedetomidine combined with propofol can be safely applied in hysteroscopic electric resection.