右美托咪定在维持腹式全子宫切除术中血流动力学稳定的作用

The effects of dexmedetomidine on maintaining hemodynamic stability during abdominal hysterectomy

目的分析全凭静脉麻醉配合右美托咪定在维持腹式全子宫切除术中血流动力学稳定的作用。方法选取该院256例行子宫切除术的患者,分为对照组和研究组,每组各128例。对照组给予等容量生理盐水,研究组给予0.2mg右美托咪定经生理盐水稀释为40mL,麻醉诱导前5min以8mL/h的速度持续泵注至患者子宫切除。比较两组患者右美托咪定使用前(T1)、子宫切除操作开始时(T2)、子宫标本切下时(T3)的心率、舒张压、收缩压及血浆去甲肾上腺素、肾上腺素及皮质醇的变化情况。结果对照组T2、T3的心率、舒张压、收缩压均高于T1,差异均有统计学意义(P<0.05),而研究组各时间段差异无统计学意义(P>0.05),且研究组T2、T3的心率、舒张压、收缩压水平均低于对照组,差异均有统计学意义(P<0.05);对照组T2、T3的去甲肾上腺素、肾上腺素及皮质醇水平均高于T1,差异均有统计学意义(P<0.05),而研究组各时间段差异均无统计学意义(P>0.05),且研究组T2、T3的去甲肾上腺素、肾上腺素及皮质醇水平均低于对照组,差异均有统计学意义(P<0.05)。结论全凭静脉麻醉配合右美托咪定在腹式全子宫切除术中能有效维持血流动力学稳定,进而减轻应激反应,具有较高的应用价值。

Objective To analyze the effects of total intravenous anesthesia with dexmedetomidine on on maintaining hemodynamic stability during abdominal hysterectomy .Methods A total of 256 cases w ho under-went hysterectomy in the hospital were enrolled in the study and divided into the control group （128 cases） and the study group （128 cases） .The control group was received the same volume of saline .In the study group ,0 .2 mg of dexmedetomidine which was diluted to 40 mL with saline was continuously infused from 5 min before induction of anesthesia at a speed of 8 mL/h until the uterine was cut .The changes of heart rate , diastolic blood pressure ,systolic blood pressure ,plasma norepinephrine ,epinephrine and cortisol levels were compared between two groups before the use of dexmedetomidine （T1 ） ,at the beginning of the uterus opera-tion （T2 ） ,when uterine specimens was cut （T3 ） .Results The heart rate ,diastolic blood pressure and systolic blood pressure at time of T2 ,T3 in the control group were higher than those at T1 ,and the differences were statistically significant （P〈0 .05） ,while these indexes in the study group at different time points showed no statistical significance （P〉0 .05） ,and the heart rate ,diastolic blood pressure and systolic blood pressure at T2 ,T3 in the study group were lower than those in the control group ,and the differences were statistically sig-nificant （P〈0 .05） .The levels of norepinephrine ,epinephrine and cortisol in the control group at T 2 ,T3 were higher than those at T1 ,and the differences were statistically significant （P0 .05） ,and the levels of norepi-nephrine ,epinephrine and cortisol at T2 ,T3 in the study group were lower than those in the control group ,and the differences were statistically significant （ P〈 0 .05） .Conclusion Intravenous anesthesia combined with dexmedetomidine in the maintenance of abdominal hysterectomy can effectively maintain the hemodynamic sta-bility and reduce the stress response ,w hich has a high value of application .