三种剂量右美托咪定在腹腔镜子宫肌瘤剔除手术患者中的全身麻醉效果观察

Effect of bservation of three doses of dexmedetomidine in patients with laparoscopic myomectomy under general anesthesia

目的观察三种剂量右美托咪定对腹腔镜子宫肌瘤剔除术患者全身麻醉效果的影响。方法选取在我院行全麻腹腔镜下子宫肌瘤剔除术患者80例,根据右美托咪定剂量将患者分为D1组(右美托咪定0.50μg/kg)、D2组(右美托咪定0.75μg/kg)、D3组(右美托咪定1.00μg/kg)和C组(生理盐水),每组20例。观察四组泵注前(T_0)、泵注结束即刻(T_1)、切皮后(T_2)、拔管前(T_3)、拔管后(T_4)的MAP、HR,记录苏醒时间、拔管时间,术后躁动、呛咳、恶心呕吐及拔管后5 min的Ramsay评分和VAS评分。结果 T_1~T_4时D1、D2、D3组MAP、HR明显低于C组(P<0.05);T_1时D3组HR明显低于D1、D2组(P<0.05),且D3组有4例患者需阿托品纠正心率。C组和D1组苏醒和拔管时间短于D2、D3组(P<0.05);C组Ramsay评分明显低于D1、D2、D3组(P<0.05),而D3组高于D1、D2组(P<0.05);C组VAS评分明显高于D1、D2、D3组(P<0.05);C组呛咳、躁动、恶心呕吐发生率显著高于D1、D2、D3组(P<0.05)。结论右美托咪定0.75μg/kg的基础量对腹腔镜子宫肌瘤术剔除手术患者的医疗转归具有一定优势。

Objective To observe the effect of three doses of dexmedetomidine in patients with laparoscopic myomectomy under general anesthesia. Methods Eighty patients given laparoscopic myomectomy under general anesthesia in our hospital were selected and randomly divided into D1 group （0.50μg/kg）, D2 group （0.75 μg/kg）, D3 group （1.00μg/kg） and C group （normal saline） according to the doses of dexmedetomidine, with 20 cases in each group. The MAP, HR before infusion （TO）, immediately after infusion （T1）, immediately after skin incision （T2）, before extubation （T3）, after extubation （T4） in the four groups were observed, and the awake time, extubation time, postoperative agitation, cough, nausea and vomiting, VAS and Ramsay scores at 5 min after extubation in the four group were compared. Results The MAP, HR at T1-T4 of group D1, D2 and D3 groups were lower than that of the group C （P〈0.05）; the HR at T1 of D3 group was lower than that of group D1 and D2 （P〈0.05）, and 4 patients in group D3 needed atropine to correct the heart rate. The awake time and extubation time of group C and group D1 were significantly shorter than those of group D2 and D3 （P〈0.05）; the Ramsay score of group C was lower than group D1, D2 and D3 （P〈0.05）, the Ramsay score of group D3 was higher than the group D1 and D2 （P〈0.05）; the VAS score of group C was significantly higher than that of the group D1, D2 and D3 （P〈0.05）; the incidence rate of cough, restlessness, nausea and vomiting incidence in the group C was higher than those of group D1, D2 and D3 （P〈0.05）. Conclusion The basal amount of dextromethorphan 0.75 μg/kg has certain advantages to the medical outcome in patients with laparoscopic myomectomy.