右美托咪定复合依托咪酯用于宫腔镜手术的麻醉效果

Anesthetic effect of dexmedetomidine combined with etomidate on hysteroscopic surgery

目的观察右美托咪定或瑞芬太尼复合依托咪酯用于宫腔镜手术的麻醉效果比较。方法选择2014年1至5月拟行宫腔镜手术患者60例,随机将患者分为D组(右美托咪定复合依托咪酯麻醉)和R组(瑞芬太尼复合依托咪酯麻醉),各30例。记录患者手术前(T0)、麻醉诱导后(T1)、扩宫时(T2)、清除肿物时(T3)、手术结束时(T4),手术结束10 min时(T5)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_2)、呼吸频率(RR);记录麻醉起效时间、手术时间、苏醒时间、离室时间;评估术前Ramsay镇静评分及术后10 min警觉/镇静观察评分;观察术中心血管用药情况及不良反应。结果两组患者T0时MAP、HR、RR、SpO_2水平比较无统计学差异(P> 0. 05)。D组各时点MAP、HR、RR、SpO_2水平比较无统计学差异(P> 0. 05);R组T1、T2、T3时MAP、HR、RR较T0时和D组显著降低(P <0. 05),T4、T5时又升高,与T0时比较无统计学差异(P> 0. 05),SpO_2水平各时点与T0时比较无统计学差异(P> 0. 05)。D组麻醉诱导时间显著短于R组(P <0. 01)。D组患者术前的Ramsay镇静评分显著优于R组(P <0. 01)。术后10 min两组警觉/镇静评分、阿托品和麻黄碱使用率、术后宫缩痛情况D组均优于R组(P <0. 01)。结论右美托咪定复合依托咪酯更适合宫腔镜短小手术,无需辅助其他麻醉药和镇痛药,即可达到足够的麻醉深度,推荐剂量的右美托咪定缓慢泵注对循环、呼吸、清醒时间和离室时间影响较小,可以减少术中心血管用药,减少术后宫缩痛。

Objective To compare the anesthetic effects of dexmedetomidine versus remifentanil combined with etomidate in hysteroscopic surgery. Methosds Sixty patients scheduled to undergo hysteroscopic surgery from January to May 2014 were randomly divided into group D（dexmedetomidine combined with etomidate,n = 30） and group R（remifentanil combined with etomidate,n = 30）. The mean arterial pressure（MAP）,heart rate（HR）,pulse oxygen saturation（SpO2）and respiratory rate（RR） were recorded before operation（T0）,after anesthesia induction（T1）,during dilatation of uterus（T2）,during tumor removal（T3）,at the end of operation（T4） and at 10 minutes after operation（T5）;the onset time of anesthesia,time of operation,awaking and leaving operation bed were recorded; Ramsay sedation score before operation and observer＇s assessment of alertness/sedation（OAA/S） score 10-minute after operation were evaluated.The cardiovascular drug use and adverse reactions during operation were observed. Results There were no significant differences in the levels of MAP,HR,RR and SpO2 at T0 between two groups（all P〉0. 05） and at each point in group D（all P〉0. 05）. In group R,MAP,HR,RR significantly decreased at T1,T2,T3（P〈0. 05） compared with T0 and corresponding time point in group D and increased at T4 and T5,which were similar to those at T0（P〉0. 05）. There were no significant differences in SpO2 level at each point（P〈0. 05）. In group D,anesthesia induction time significantly shortenedcompared with group R（P〈0. 01）. The preoperative Ramsay sedation score,postoperative 10 mins OAA/S score,use of atropine and ephedrine,postoperative uterine contraction pain situation in group D were significantly better than thosein group R（all P〈0. 01）. Conclusions Dexmedetomidine combined with etomidate is more suitable for hysteroscopic short-time surgery andcan achieve sufficient depth of anesthesia without the assistance of other anesthetics and analgesics.The recommended dose of dexmedetomidine pumped slowly has little effects on circulation,breathing,time of awaking and leaving the operation room and can reduce intraoperative cardiovascular drugs and postoperative pain of uterus contraction.