子宫切除术麻醉诱导前静脉泵注右美托咪定效果观察

Induction of Anesthesia Intravenous Infusion of Dexmedetomidine for Hysterectomy: Efficacy and Safety Evaluation

目的探讨子宫切除术麻醉诱导前静脉泵注右美托咪定的效果及安全性。方法选择本院妇科2012年4月—2014年3月收治的120例择期行全身麻醉腹腔镜子宫切除术患者,采用随机数字表法随机分为观察组和对照组各60例。两组均常规手术,观察组在麻醉诱导前10 min内静脉恒速泵注右美托咪定1μg/kg,继以0.5μg/(kg·h)恒速输注维持至手术结束前30 min;对照组常规麻醉诱导,不辅助用药。观察两组手术后即刻、手术后24 h、拔出气管导管1 h后视觉模拟评分(VAS);术后72 h内痛觉过敏反应发生率、追加镇痛剂例数、镇痛泵按压次数,以及观察组药物不良反应发生情况。结果观察组手术后即刻、拔出气管导管1 h、手术后24 h VAS评分均明显低于对照组,差异均有统计学意义(P<0.05或P<0.01);观察组术后72 h内痛觉过敏反应发生率低于对照组,追加镇痛剂例数、镇痛泵按压次数均少于对照组,差异均有统计学意义(P<0.05或P<0.01);观察组术后出现头晕、恶心呕吐等症状6例(10.0%),对症处理缓解。结论子宫切除术麻醉诱导前静脉泵注右美托咪定能减轻术中及术后患者疼痛,且安全性较高,值得临床推广应用。

Objective To investigate the hysterectomy before induction of anesthesia intravenous infusion of dexme- detomidine and evaluate its effect and safety. Methods 120 patients, admitted to our hospital during April 2012 and March 2014 for laparoscopic hysterectomy under general anaesthesia, were randomly divided into observation group （n = 60） and control group （ n = 60） according to random number table. Both groups underwent routine surgery and observation group was given constant rate intravenous infusion of dexmedetomidine 1 p^g/kg, within 10 min before induction of anesthesia and fol- lowed with 0.5 p^g/（ kg ~ h） to maintain a constant rate infusion until 30 min before the end of surgery; the control group was given conventional induction of anesthesia with no adjuvants. Immediately after surgery, 24 h after surgery and I h after endo- tracheal tube was pulled out, visual analog scale （VAS） of the two groups were observed as well as pain within 72 h after the incidence of allergic reactions, additional analgesics number of cases, analgesia press times and the incidence of adverse drug reactions of observation group. Results VAS scores of the observation group immediately after surgery, 1 h after endotracheal tube was pulled out, and 24 h after surgery were significantly lower than that of the control group, and the difference was sta- tistically significant （ P 〈 0.05 or P 〈 0.01 ） ; the incidence of allergic reactions pain of the observation group 72 h after sur- gery was lower than that of the control group, the number of cases of additional analgesics, analgesic pump pressing times were less than that of the control group, and the difference was statistically significant （P 〈 0.05 or P 〈 0.01 ）; in observation group there were 6 cases （10.0%） of dizziness, nausea, vomiting and other symptoms, and symptoms were relieved after treatment. Conclusion Hysterectomy before induction of anesthesia intravenous infusion of dexmedetomidine may reduce the intraoperative and postoperative pain with good safety and is worthy of clinical application.