右美托咪啶不同给药剂量在妇科腹腔镜手术中的应用效果比较

Application effect on gynecological laparoscopic surgery patients by different dexmedetomidine doses

目的 分析右美托咪啶不同给药剂量在妇科腹腔镜手术患者中的应用效果.方法 将100例妇科腹腔镜手术患者按随机数字表法分为对照组和观察组,每组50例.观察组患者麻醉诱导插管前15 min静脉注射右美托咪定0.5μg/kg,而对照组患者则给予1.0μg/kg,继以0.4μg/ （kg·min）持续静脉泵入.两组患者均采用静脉注射咪达唑仑、枸橼酸芬太尼、丙泊酚、苯磺顺阿曲库铵进行麻醉诱导,术中持续静脉泵注瑞芬太尼和丙泊酚维持麻醉深度,间断注射苯磺顺阿曲库铵维持肌松,两组患者均于手术结束前30 min静脉注射地佐辛0.1 mg/kg.比较两组患者简易智能状态检查量表（MMSE）评分、躁动程度（采用躁动评分）、镇静效果（采用Ramsay镇静评分）、苏醒时间、拔管时间和药物不良反应.结果 观察组术后认知功能障碍、药物不良反应发生率明显低于对照组[10％（550）比32％（16/50）、10％（5/50）比40％ （20/50）],Ramsay镇静评分明显低于对照组[（1.04±0.59）分比（4.84±0.63）分],苏醒时间、拔管时间明显短于对照组[（20.14±4.32） min比（26.57±4.28）min、（20.17±4.23） min比（27.26±4.34） min],差异有统计学意义（P＜0.05）.两组麻醉前、麻醉后24 h MMSE评分比较差异无统计学意义（P＞0.05）,观察组麻醉后1,6,12 h MMSE评分均明显高于对照组[（23.93±3.51）分比（20.34±3.45）分、（25.87±4.46）分比（21.34±4.63）分、（27.53±4.22）分比（23.49±4.31）分],差异有统计学意义（P＜0.05）.结论 按照0.5μg/kg给予右美托咪啶能够减少妇科腹腔镜手术患者术后认知功能的改变,具有镇静效果好,药物不良反应少等优点,值得在临床工作中推广应用.

Objective To analyze the application effect on gynecological laparoscopic surgery patients by different dexmedetomidine doses.Methods One hundred gynecological laparoscopic surgery patients were divided into control group and observation group by random digits table method with 50 cases each.The patients in observation group were given dexmedetomidine 0.5 μ g/kg intravenous injection 15 min before induction of anesthesia intubate,the patients in control group were given dexmedetomidine 1.0 μ g/kg,then 0.4 μ g/（kg· min） continuing venous pumping.The induction of anesthesia program in the 2 groups was midazolam,fentanyl citrate,propofol,cisatracurium besilate intravenous injection,maintaining intraoperative depth of anesthesia program was remifentanil and propofol by continuing venous pumping,and the maintaining muscle relaxation program was cisatracurium besilate interruptable injection.The patients in the 2 groups were given dezocine 0.1 mg/kg intravenous injection 30 min before the end of operation.The man-machine system engineering （MMSE） score,restlessness degree （using restlessness score）,sedation effect （using Ramsay sedation score）,analepsia time,extubation time and drug adverse reaction were compared.Results The rates of postoperative cognitive dysfunction and drug adverse reaction in observation group were significantly lower than those in control group [10%（5/50） vs.32%（16/50）,10%（5/50） vs.40%（20/50）],Ramsay sedation score,analepsia time and extubation time were significantly lower than those in control group [（1.04 ± 0.59） scores vs.（4.84 ± 0.63） scores,（20.14 ± 4.32） min vs.（26.57 ± 4.28） min,（20.17 ± 4.23） min vs.（27.26 ± 4.34） min],there were statistical differences （P 〈 0.05）.There was no statistical difference in MMSE score before anesthesia and 24 h after anesthesia between the 2 groups （P 〉 0.05）,but MMSE score 1,6,12 h after anesthesia in observation group was significantly higher than that in control group [（23.93 ±3.51） scores vs.（20.34 ±3.45） scores,（25.87 ±4.46）scores vs.（21.34 ±4.63） scores,（27.53 ± 4.22） scores vs.（23.49 ± 4.31） scores],there was statistical difference （P 〈 0.05）.Conclusions Dexmedetomidine in accordance with 0.5 μ g/kg can reduce the incidence of postoperative drug cognitive dysfunction in the patients after gynecological laparoscopic surgery,it has good calming effect and less adverse reactions.It is worthy of popularization and application in the clinical work.