宫颈锥切术中右美托咪定对宫肌注射垂体后叶素不良反应的影响

Effects of dexmedetomidine on adverse reaction of pituitrin injection to uterus muscle in conization of cervix

目的探讨右美托咪定能否对抗宫颈锥切术中宫肌注射垂体后叶素的不良反应。方法收集2013年12月~2015年6月我院收治的择期行宫颈锥切术的患者150例,ASAⅠ~Ⅱ级,随机分为3组,每组50例。对照组(C组):不注射任何镇静药;咪达唑仑组(M组):注射2 mg咪达唑仑镇静;右美托咪定组(D组):右美托咪定0.5μg/kg,10 min输注完毕,维持剂量2.5μg/(kg·h)。3组患者0.75%罗哌卡因连续硬膜外麻醉后分别注射生理盐水或咪达唑仑或右美托咪定,并均于切宫颈前宫肌注射垂体后叶素。分别测定3组患者基础(T_0),宫肌注射垂体后叶素前(T_1),宫肌注射垂体后叶素后1 min(T_2)、2 min(T_3)、3 min(T_4)、5 min(T_5)、10 min(T_6)、15 min(T_7)、30 min(T_8)、45 min(T_9)的血压、心率、血氧饱和度,并记录恶心呕吐、胸闷、头痛情况。结果 T_0、T_1时间点3组的血压、心率比较差异无统计学意义(P>0.05);T_2~T_9时C、M组血压、心率明显高于T_0、T_1时,D组的血压、心率明显低于C、M组(P<0.05);3组各个时间点血氧饱和度无明显变化(P>0.05);D组恶心呕吐、胸闷、头痛的发生率明显低于C、M组(P<0.05)。结论 0.5μg/kg诱导量加2.5μg/(kg·h)维持量的右美托咪定能降低宫肌注射垂体后叶素引起的高血压,减少恶心呕吐、胸闷、头痛的发生。

Objective To discuss the counteraction of dexmedetomidine against adverse reaction of pituitrin injection to uterus muscle in conization of cervix.Methods 150 patients receiving conization of cervix（ASA I^II）in our hospital from December 2013 to June 2015 were selected and randomly divided into three groups,with 50 patients in each group.Patients in the control group（group C）were not treated by any sedative.Patients in the midazolam group（group M）were treated by 2 mg midazolam.While patients in the dexmedetomidine group（group D）were treated by 0.5 μg/kg dexmedetomidine,infused within 10 min with a maintaining dose of 2.5 μg/（kg·h）.Patients among three groups were given epidural anesthesia by 0.75% ropivacaine,followed by normal saline,midazolam,or dexmedetomidine,and were all injected by pituitrin to uterus muscle before conization of cervix.The following indicators among the three groups were detected：blood pressure,heart rate,and oxyhemoglobin saturation,at time of entering the operation room（T_0）,time before injection of pituitrin to uterus muscle（T_1）,and 1 min（T_2）,2 min（T_3）,3 min（T_4）,5 min（T_5）,10 min（T_6）,15 min（T_7）,30 min（T_8）,and 45 min（T_9）after injection of pituitrin to uterus muscle.And the incidences of nausea,vomiting,chest tightness,and headache were recorded.Results There was no significant difference in blood pressure and heart rate at T_0 and T_1among the three groups（P0.05）.At T_2-T_9,the blood pressure and heart rate in group C and group M was evidently higher than that at T_0 and T_1respectively,the blood pressure and heart rate in group D was evidently lower than that of group C and group M（P0.05）.There was no obvious change in oxyhemoglobin saturation in each group at any time points（P0.05）.The incidences of nausea,vomiting,chest tightness,and headache in group D was significantly lower than that of group C and group M respectively（P0.05）.Conclusion Dexmedetomidine at induced dose of 0.5 μg/kg plus maintenance dose of 2.5 μg/（kg·h）can reduce the incidence of nausea,vomiting,chest tightness,and headache caused by pituitrin injection to uterus muscle.