右美托咪定在腹腔镜全子宫切除术中的应用效果

Efficacy of Dexmedetomidine in Treatment of Laparoscopic Panhysterectomy

目的:探讨右美托咪定在腹腔镜全子宫切除术中的应用效果及对抗凝血酶(AT)Ⅲ、D-二聚体(D-D)、纤维蛋白降解产物(FDP)、皮质醇(Cor)的影响。方法:选择2015年5月至2016年10月我院接诊的90例行腹腔镜全子宫切除术的患者,通过随机数表法分为观察组(n=45)和对照组(n=45)。两组均采用静脉吸入复合全麻,观察组在入室后给予1μg/kg的右美托咪定(10 min内完成输注),之后以0.5μg/(kg·h)的速度持续泵注,持续输注60 min;对照组以同样的方式输注生理盐水。比较两组在T_0(麻醉前)、T_1(麻醉后10 min)、T_2(拔管后)、T_3(术后24 h)各时点血流动力学、纤溶功能及应激反应的变化。结果:对照组在T_1、T_2时平均动脉压(MAP)、心率(HR)较T0时点显著升高(P<0.05),T_3时回落至正常水平;观察组各时点MAP、HR均无明显变化(P>0.05);两组T_1、T_2时点ATⅢ均显著降低,D-D、FDP显著升高(P<0.05),观察组T_3时点ATⅢ、D-D、FDP均恢复到正常水平,与T0时比较无显著差异(P>0.05),但对照组各指标和T_0时比较仍具有显著差异(P<0.05),观察组在各时点ATⅢ均高于对照组,D-D、FDP均低于对照组(P<0.05);与T_0比较,两组T_1、T_2、T-3时点Cor均显著升高(P<0.05);但观察组在T_1、T_2、T_3时点Cor均比对照组低(P<0.05)。结论:右美托咪定用于腹腔镜全子宫切除术有助于维持患者血流动力学稳定,改善应激反应及纤溶功能,麻醉效果优异。

Objective： To study the efficacy of dexmedetomidine in the treatment of laparoscopic panhysterectomy and its effects on the serum antithrombin（AT） Ⅲ, D-dimer（D-D）, Fibrin degradation product（FDP） and cortisol（Cor） levels. Methods： 90 patients of laparoscopic panhysterectomy who were treated from May 2015 to October 2016 in our hospital were selected. According to the random number table, those patients were divided into the observation group（n=45） and the control group（n=45）. The observation group was given 1 μg/kg dexmedetomidine after entering the operation room（complete infusion within 10 min）, then 0.5 μg/（kg·h）of the speed of continuous pump, continuous infusion for 60 minutes, the control group received saline in the same way. The changes of hemodynamics,fibrinolytic function and stress response were compared between the two groups at T_0（before anesthesia）, T_1（after anesthesia10 min）, T_2（after extubation）, T_3（postoperative 24 h）. Results： At T_1 and T_2, the mean arterial pressure（MAP） and heart rate（HR） in the control group were significantly higher than those of T_0（P0.05）, and T_3 down to normal level; there was no significant change in MAP and HR at each time point in the observation group（P0.05）; At T_1 and T_2 point, the ATⅢ in two groups significantly reduced, D-D and FDP significantly increased（P0.05）. At T_3 point, the ATⅢ, D-D and FDP in the observation group restored to normal level, and there was no significant difference compared with T_0（P0.05）, but there were significant differences in the control group compared with T_0 point（P0.05）; The AT III in the observation group were higher than that of the control group at each time point, and the D-D and FDP were lower than those of the control group（P0.05）; Compared with T_0 point, two groups Cor at T_1, T_2 and T_3 point significantly increased（P 0.05）; Cor in the observation group were lower than that of the control group at T_1, T_2 and T_3 point（P 0.05）. Conclusion：Laparoscopic hysterectomy combined with dexmedetomidine contributed to maintain the hemodynamic stability, improve the stress response and fibrinolytic function, the anesthesia effect was good, it＇s worthy of application and promotion.