不同时机使用右美托咪啶对妇科腹腔镜手术患者血流动力学及术后疼痛的影响

Effects of dexmedetomidine on hemodynamics and postoperative pain in patients undergoing gynecologic laparoscopic surgery at different time points

目的探讨不同时机使用右美托咪啶对妇科腹腔镜手术患者血流动力学及术后疼痛的影响。方法选择2014年1月至2016年1月择期行妇科腹腔镜手术的90例ASA分级Ⅰ~Ⅲ级的患者作为研究对象,按随机数字表分为三组,均采用静吸复合麻醉,输注瑞芬太尼、丙泊酚和七氟醚,维持BIS 40~60,A组30例,于诱导前15 min使用右美托咪啶,0.6μg/kg,B组30例,于术毕前15 min使用右美托咪啶,0.6μg/kg,C组30例,给予注射生理盐水。观察三组患者的麻醉药物起效时间、维持时间和术后苏醒时间,术前及术后12 h、24 h、72 h血流动力学指标(心率、平均动脉压)变化,术后各时间节点VAS评分。结果三组患者的麻醉药物起效时间和苏醒时间比较差异无统计学意义(P>0.05),三组维持时间比较差异有统计学意义(P<0.001),A组维持时间长于B组和C组,B组又长于C组(P<0.05或0.01)。三组患者术前的平均动脉压(MAP)和HR比较差异无统计学意义(P>0.05);术后12 h、24 h及72 h时,三组的MAP和HR均逐渐恢复正常,其中,术后12 h时,A组的MAP优于B组和C组,HR优于C组(P<0.05或0.01)。术后12 h、24 h及72 h时,三组的VAS评分均逐渐降低,其中,三个时间点,A组和B组的VAS评分均低于C组(P<0.01),A组和B组的VAS评分比较差异无统计学意义(P>0.05)。结论不同时机应用右美托咪啶于妇科腹腔镜手术均可以缓解患者疼痛,麻醉疗效显著,但在保证安全的前提下,优先推荐诱导前15 min使用右美托咪啶的方案,该方案维持血流动力学更稳定,药物持续时间更长。

Objective To investigate the effects of dexmedetomidine on postoperative pain and hemodynamics in patients undergoing gynecological laparoscopic surgery at ditterent time points.Methods From January,2014 to January,2016,90 patients with ASA grade Ⅰ-Ⅲ undergoing gynecological laparoscopic surgery were selected as research objects.They were divided into three groups according to random number table.All of them were treated with intravenous inhalation combined anesthesia, intusion of remitentanil, propofol and sevoflurane to maintain BIS 40-60. Group A （n = 30） were given 0.6 μg/kg of dexmedetomidine 15 rain bofore induction, Group B （n = 30） were treated with 0.6 μg/kg of dexmedetomidine 15 rain before the end of operation,and group C （n=30） were given injection of saline.The onset time,maintenance time of anesthetic drugs and postoperative recovery time as well as the changes of hemodynamic indexes（ heart rate and mean arterial pressure, MAP） before operation and 12 h, 24 h and 72 h after operation were compared.In addition, VAS scores at each time point after operation were compared between the three groups.Results Difference of the onset time of anesthetic drugs and recovery time of the three groups was not statistically significant（ P〉0.05 ）.The ditterence of maintenance time among the three groups was statistically significant（ P〈0.001 ） , the maintenance time of the group A was longer than that of the group B and the group C, and that of the group B was longer than that of the group C （P〈0.05 or 0.01 ）.There was no statistically significant difference in MAP and HR between the three groups before operation（P〈0.005）,but they gradually returnde to normal 12 h,24 h and 72 h after operation .12 h after operation ,the MAP of the group A was better that of the group B and the group C ,and HR was better than that of the group C （P〈0.005 or 0.01）.12 h,24 h and 72 h after operation ,the VAS scoers of the three groups decreased gradually ,and the VAS scores of the group A and group B were lower than those of the group C at the three time points（P〈0.001）.These was no statistically significant difference in VAS scores between the group A and group B （P〉0.05）.Conclusion To use dexmedetomidine at different times in gynecological laparoscopic surgery can relieve the pain of patients to some extent , and anesthetic effect is remarkable.However,under the condition of safely,priority should be given to the regimen of the use of dexedetomidine 15 min before induction,which maintains more stabile hemodynnamics and longer drug duration.