右美托咪定减轻人工流产术中手术应激反应的效果

Efficacy of dexmedetomidine in attenuating stress respose to artificial abortion

目的探讨右美托咪定减轻人工流产(人流)术中手术应激反应的效果。方法接受无痛人流术患者80例,均采用丙泊酚2mg/kg麻醉。随机均分为四组:D1组麻醉诱导前10min内输注右美托咪定0.5μg/kg;D2组术中持续输注右美托咪定0.2μg·kg^(-1)·h^(-1)至手术结束;D3组于麻醉诱导前10min内输注右美托咪定0.5μg/kg,其后持续输注右美托咪定0.2μg·kg^(-1)·h^(-1)至手术结束;C组不用右美托咪定作为对照。记录麻醉前(T1)、手术开始(T2)、扩宫颈(T3)和术毕(T4)的MAP、HR、SpO_2和脑电双频指数(BIS)。检测T1~T4时的血浆肾上腺素(E)、去甲肾上腺素(NE)和皮质醇(Cor)浓度。结果 D1、D2和D3组术中T2~T4时MAP、HR、BIS值和丙泊酚用量均低于C组(P<0.05)。D1、D2和D3组术中T2~T4时血浆E、NE和Cor浓度均低于C组(P<0.05)。D3组的以上变化较D1和D2组更为明显(P<0.05)。结论右美托咪定可明显减轻人流手术患者的应激反应,增强丙泊酚麻醉效果,维持循环稳定,提高苏醒质量。

Objective To investigate the efficacy of dexmedetomidine in attenuating stress respose to artificial abortion.Methods Eighty patients received painless artificial abortion under propofol anesthesia,who were equally rendomized into four groups of D1（infusion of dexmedetomidine 0.5μg/kg in 10 minutes before anesthesia）,D2（infusion of dexmedetomidine 0.2μg·kg-1·h-1 during operation till the end of surgery）,D3（infusion of dexmedetomidine 0.5μg/kg in 10 minutes before anesthesia followed by 0.2μg·kg-1·h-1 during operation）and C（without infusion of dexmedetomidine）.The HR,MAP,SpO2 and bispectral index（BIS）were recorded before anesthesia induction（T1）,at the beginning of surgery（T2）,enlargement of the cervix（T3）and the end of operation（T4）.Plasma concentrations of epinephrine（E）,norepinephrine（EN）and cortisol（Cor）were detected at T1-T4.Results HR,MAP and BIS at T2-T4 were lower in groups of D1,D2 and D3 than those in group C（P〈0.05）.So did the consumption of propofol（P〈0.05）.Plasma concentrations of E,EN and Cor at T2-T4 were lower in groups of D1,D2 and D3 than those in group C（P〈0.05）.The indicators mentioned above were lower in group D3 than those in groups of D1 and D2（P〈0.05）.Conclusion Dexmedetomidine can effectively attenuate stress response to artificial abortion,enhance the efficacy of propofol anesthesia,maintain circulation stable and improve the quality of wakening.