右旋美托咪啶辅助基础麻醉在宫腔镜手术中的应用研究

Application of dexmedetomidine assisted basic anesthesia in hysteroscopic surgery

目的探讨右美托咪啶辅助基础麻醉行宫腔镜手术的麻醉效果及安全性。方法选择ASAⅠ或Ⅱ级择期行宫腔镜下宫颈息肉电切术的患者60例,采用随机数字表法将患者分为右美托咪啶组(D组)和对照组(N组),每组30例。两组患者麻醉方法均采用基础麻醉(舒芬太尼0.2μg/kg,布托啡诺0.02mg/kg),D组麻醉前十分钟静脉泵注右美托咪啶(负荷量0.5μg/kg,15min内注射完毕,维持量0.2μg/(kg·h)至术毕),N组用同样方式静脉泵注等量生理盐水。记录麻醉前5min(T1),给药后10min(T2),扩宫颈(T3),膨宫时(T4)术中电切时(T5),术毕10min(T6)的MAP、HR、SPO2,评估并记录各时间点的Ramsay镇静评分;观察两组患者在扩宫颈、膨宫和电切时的疼痛评分(数字疼痛评分法),4~6分采用心理安抚,酌情追加布托菲诺1mg,7分以上追加舒芬太尼5μg,处理后仍>7分改用静脉全麻,同时该患者剔出本次研究。记录患者术中的用药总量;记录不良反应的发生如呼吸抑制、头晕、恶心呕吐以及患者的满意度。结果 D组在扩张宫颈、膨宫以及电切时的疼痛评分及用药总量较N组明显减少(P<0.05);与N组患者相比,D组患者能得到更恰当的镇静效果(P<0.05);不良反应的发生率D组比N组明显减少(P<0.05),D组患者满意度较高(P<0.05)。结论右美托咪啶辅助基础麻醉行宫腔镜下宫颈息肉电切术能有效减少精神类药物的应用,减少不良反应的发生,缓解患者术前、术中的紧张心理,使患者在诊疗过程中更加舒适,增加满意度。

Objective To investigate the effect and safety of dexmedetomidine assisted basic anesthesia in hysteroscopy. Methods Sixty patients with ASA I or II for elective resection of cervix polyps under hysteroscopy were selected.They were divided into the dexmedetomidine group （group D） and the control group （group N）,with 30 cases in each group.The patients of two groups were anesthetized with basic anesthesia （sufentanil 0.2 μg/ kg,butorphanol 0.02mg/kg）.The group D was injected with dexmedetomidine ten minutes before anesthesia （load capacity 0.5μL g/kg,completed within 15 minutes,maintenance of 0.2 μ g/（kg · h） to the end of the operation）.The group N was injected with the same amount of normal saline in the same way.5 min before anesthesia （T1）,10 min after administration （T2）,cervical dilatation （T3）,dilatation （T4）,intraoperative electrical resection （T5）,postoperative 10 min （T6）,MAP,HR,SPO2 were recorded.The Ramsay sedation score at each time point was ,evaloated and recorded. The pain scores （digital pain scores） were observed in the patiets of two groups at the time of enlargement of the cervix,dilatation,and clectrocutting.4 ~ 6 points with psychological comfort,and add butorphanol 1mg, as appropriate.More than 7 points plus sufentanil 5μg,after the treatment still greater, than 7 points with intravenous anesthesia.At the same time,the patients should be removed in this study.The total amount of drug used in the operation,adverse reactions such as respiratory depression,dizziness,nausea and vomiting,and patient satisfaction were recorded. Results The pain scores and the total dosage of dilated cervix,dilatation and electric cutting in the group were significantly less than that of the group N （P 〈 0.05）;Compared with the group N,the patients in group D were able to get more appropriate sedative effects （P 〈 0.05）.The incidence of adverse reactions in the group D was significantly lower than that in the group N （P 〈 0.05）,and the patients in the group D had a higher degree of satisfaction （P 〈 0.05）. Conclusion Dexmedetomidine combined with basal anesthesia for hysteroscopic cervical polyp electrotomy can effectively reduce the application of psychotropic drugs,reduce the occurrence of adverse reactions,relieve the tension of patients before and during operation,and make patients more comfortable and satisfied with the diagnosis and treatment process.