盐酸右美托咪啶预防妇科腹腔镜手术全麻患者苏醒期心血管反应的临床研究

Preventive effects of dexmedetomidine hydrochloride on cardiovascular responses in anesthesia recovery period of gynecological laparoscopic surgery

目的探讨盐酸右美托咪啶对妇科腹腔镜术中全麻患者心血管反应的预防作用。方法将择期妇科腹腔镜手术全麻患者70例,采用随机数字表法分为盐酸右美托咪啶治疗组(A组)和对照组(B组),各35例。A组于气管插管诱导前10min静脉泵注盐酸右美托咪啶0.5μg/kg,泵注持续时间为10min,术中静脉持续泵注盐酸右美托咪啶0.4μg/(kg·h);B组缓慢注射0.9%氯化钠溶液10mμ。监测患者麻醉自主呼吸恢复时、拔管前、拔管时和拔管后10min的心率(HR)、心率收缩压乘积(RPP)、平均动脉压(MAP),记录术后患者自主呼吸恢复时间、苏醒时间、拔管时间。结果两组患者在自主呼吸恢复时、拔管前血流动力学指标HR、MAP、RPP差异均无统计学意义(均P>0.05),拔管时和拔管后10min上述指标差异有统计学意义(均P<0.05),A组在拔管时和拔管后10min上述指标无明显变化(均P>0.05),而B组拔管时和拔管后10min上述指标较拔管前有明显升高(P<0.05),两组患者的自主呼吸恢复时间、苏醒时间和拔管时间基本一致,差异均无统计学意义(均P>0.05)。结论盐酸右美托咪啶可保持全麻苏醒期的血流动力学稳定,对麻醉恢复期也无明显影响,有效预防妇科腹腔镜手术全麻患者苏醒期心血管反应的发生。

Objective To investigate the effect of dexmedetomidine hydrochloride on cardiovascular response in anes-thesia recovery period of laparoscopic gynecological surgery. Methods Seventy patients undergoing elective laparoscopic surgery under general anesthesia were divided into dexmedetomidine hydrochloride treatment group （group A, n=35） and con-trol group （group B, n=35）. In group A 0.5μg/kg dexmedetomidine hydrochloride was infused intravenously 10 min before in-duction, then a dose of 0.4μg/ （kg·h） continuous intravenous infusion was given intraoperatively;group B was given slow in-jection of 0.9%sodium chloride solution 10ml instead. Heart rate （HR）, rate pressure product （RPP） and mean arterial pressure （MAP） were monitored at restoration of spontaneous breathing, before extubation, extubation and 10min after extubation;the time of spontaneous breathing recovery, the anesthesia recovery time, extubation time were recorded. Results There were no dif-ferences in HR, MAP, RPP during spontaneous breathing restored between two groups （P〉0.05）, but differences at extubation and 10min after extubation （P〈0.05）. There were no significant changes in hemodynamic indexes between extubation and 10 min after extubation in group A （P〉0.05）, while there were significant differences in group B（P〈0.05）. There were no significant differences in spontaneous breathing recovery time, anesthesia recovery time and extubation time between two groups （P〉0.05）. Conclusion Dexmedetomidine hydrochloride can maintain stable hemodynamics at anesthesia recovery period and pre-vent cardiovascular reactions in laparoscopic gynecological surgery.