不同剂量右美托咪定联合舒芬太尼用于腹腔镜妇科手术的疗效观察

Observation of Anesthetic Effect of Dexmedetomidine Combined with Sufentanil in Laparoscopic Gynecological Surgery at Different Doses

目的:观察不同剂量右美托咪定联合舒芬太尼在腹腔镜妇科手术麻醉的效果与安全性。方法:选择腹腔镜妇科手术的病例300例,随机分为高、中、低剂量三组,分别采用0.3μg/(kg·h)、0.6μg/(kg·h)、0.9μg/(kg·h)三个剂量的右美托咪定联合舒芬太尼镇痛。比较三组患者诱导前、插管时、手术开始时、气腹时、术中30 min时、手术结束时的心率、动脉血压变化、氧饱和度变化以及麻醉苏醒情况、不良反应情况。结果:低剂量组在插管时和气腹时动脉压和心率比诱导前明显升高,中、高剂量组插管时动脉压与心率无明显升高,而术中30 min三组的动脉压和心率均明显低于诱导前(P<0.05)。组间比较:低剂量组在插管时和手术开始时心率与血压显著高于另外两组(P<0.05);而高剂量组在术中30 min时动脉压和心率均最低,苏醒时间最长(P<0.05),不良反应比例最高(P<0.05)。结论:中剂量的右美托咪定与舒芬太尼联合用在腹腔镜妇科手术中镇痛效果好,术中心率血压平稳,结束后苏醒快、并发症少。

Objective ： To observe the anesthetic efficacy and safety of dexmedetomidine combined with sufentanil at different doses in laparoscopic gynecological anesthesia. Methods： 300 cases of laparoscopic gynecological surgery patients in our hospital were randomly divided into three groups： low dose group, middle dose group and high dose group. In the three groups, 0.3μg/（kg·h）、0.6μg/（kg·h）、0.9μg/（kg·h）dexmedetomidine combined with snfentanil analgesia was used, respectively. The heart rate, arterial blood pressure, oxygen saturation, anesthesia awakening and adverse reactions were recorded. Results： The arterial pressure and heart rate at the time of intubation and pneumoperito- neum were significantly higher than that before operation in the low dose group （P〈0.05）. There was no significant increase in arterial pressure and heart rate during intubation and pneumoperitoneum in the middle dose group and the high dose group. The arterial pressure and heart rate at 30min after operation and the end of operation were significantly lower than that before induction （P〉0.05）. The arterial pressure and heart rate at the time of intubation and pneumoperi- toneum in low dose group were significantly higher than those in the other two groups （P〈0.05）. The arterial pressure and heart rate at 30min after operation and the end of operation in high dose group were both lowest （P 〈0.05 ）. The recovery time and adverse effect rate of high dose group wereboth highest （P〈0.05）. Conclusion ： The analgesic effect of middle dose of dexmedetomidine combined with sufentanil in laparoscopic gynecological surgery in is good. The intra- operative heart rate and blood pressure is stable, the recovery is rapid, and the risk of surgical complications is low.