右美托咪定在宫腹腔镜手术镇痛中的效果评价

Effect evaluation of Dexmedetomide in analgesia of hysteroscopy laparoscopy surgery

目的探讨右美托咪定在宫腹腔镜手术镇痛中的临床效果及安全性。方法选取2015年1~12月我院收治的100例宫腹腔镜手术患者,采用数字表法随机分为观察组和对照组,各50例。两组患者均采用异丙酚+罗库溴铵+芬太尼进行麻醉诱导,异丙酚+瑞芬太尼进行麻醉维持,观察组在此基础上于麻醉诱导后给予右美托咪定静脉持续泵注,对照组则给予等量生理盐水静脉泵注。记录两组患者入室后(t0)、手术开始后10 min(t1)、手术开始后20 min(t2)、手术结束时(t3)、拔除气管导管时(t4)时的心率、平均动脉压和脑电双频谱指数(BIS),采用数字模拟评分法(VAS)评价两组患者术后3、6、12、24 h时的疼痛程度,对比两组患者术后的不良反应发生率。结果两组患者t1~t4(两组t4时的心率除外)的心率、平均动脉压及BIS评分与t0时对比差异有统计学意义(P<0.05);观察组患者在t1、t4时的心率及平均动脉压显著低于对照组,t1、t2、t3时的BIS显著低于对照组(P<0.05),其余时间点两组患者的各项指标差异无统计学意义(P>0.05);术后3、6、12、24 h时,观察组患者的VAS评分均显著低于对照组,差异有统计学意义(P<0.05);观察组患者术后未出现恶心呕吐、寒战等表现者,对照组患者出现恶心呕吐5例,寒战4例,不良反应发生率为18.0%,两组对比差异有统计学意义(P<0.05)。结论右美托咪定应用于宫腹腔镜手术患者的镇痛能够有效减轻患者的术后疼痛感,控制术后不良反应的发生,安全性较好,值得临床推广应用。

Objective To investigate the clinical effect and safety of Dexmedetomidine in analgesia of hysteroscopy la- paroseopy surgery.Methods 100 patients undergoing hysteroscopy laparoscopy surgery treated in our hospital from Jan- uary to December 2015 were randomly divided into observation group （50 cases） and control group （50 eases）.All pa- tients were given anesthesia induction with Propofol and Roeuronium Bupropion＋Fentanyl,Propofol ＋Remifentanil were used to maintain anesthesia,on this basis,the observation group was given Dexmedetomidine for vein continuous injec- tion after anesthesia induction,while the control group was given equal normal saline for intravenous infusion.Heart rate, mean arterial pressure and bispectral index （BIS） after entering （t0）,10 rain after the start of operation （t1）,20 min after the start of operation （t2）,at the end of operation （t3）,when extubation （t4） patients in two groups were recorded,and the digital analog scale （VAS） was used to evaluate the degree of pain after 3,6,12,24 h operation in two groups,and the in- cidence rate of adverse reactions were compared between two groups.Results There was significant difference in heart rate,mean arterial pressure and BIS score at t1-t4 （except for heart rate of t4 in two groups） to between two groups （P〈0.05）. The heart rate and mean arterial pressure of the observation group were significantly lower than those of the control group at t1 and t4,and BIS was significantly lower than those of the control group at t1-t4 comared with except fo heart rate of t4 in two groups t1,t2 and t3 （P〈0.05）,and there was no statistical difference of various indexes at other time points between two groups （P〉0.05）.VAS score of the observation group was significantly lower than that of the control group at 3,6,12,24 h after operation （P〈0.05）.It had no nausea and vomiting,shiver,while there were 5 cases of nausea and vomiting,4 cases of shiver and its incidence rate of adverse reactions was 18.0% in the control group,and there was a significant difference between two groups （P〈0.05）.Conclusion Dexmedetomidine can be used in patients undergoing hysteroseopy laparoscopy surgery to relieve the postoperative pain and to control the occurrence of postoperative ad- verse reactions.It is safe and worthy to be popularized and applied in clinical practice.