腹腔镜手术应用右美托咪定与咪达唑仑麻醉效果比较

Comparison of anesthesia effect between dexmedetomidine and midazolam during laparoscopic surgery

目的比较右美托咪定与咪达唑仑在腹腔镜手术中的麻醉效果。方法选取2017年1月-2019年1月于广东省清远市清新区人民医院行腹腔镜手术治疗的患者50例,采用随机数字表法分为右美托咪定组和咪达唑仑组,每组25例。麻醉诱导前10 min右美托咪定组给予右美托咪定静脉泵注,咪达唑仑组一次性给予咪达唑仑静脉注射,2组均予芬太尼、丙泊酚、顺阿曲库铵完成麻醉诱导插管,术中麻醉维持吸入七氟烷,根据血压、麻醉深度监测情况追加芬太尼。比较麻醉前(T0)、麻醉后10 min(T1)、插管1 min后(T2)、手术气腹时(T3)、拔管后(T4)2组心率(HR)、平均动脉压(MAP)、术中芬太尼追加次数、拔管时间、拔管后15 min OAA/S镇静评分、视觉模拟评分法(VAS)评分。结果与T0比较,右美托咪定组T1时HR明显下降(P<0.05),咪达唑仑组T2、T3、T4时HR、MAP明显上升(P<0.05);T1、T2、T3、T4时右美托咪定组HR明显低于咪达唑仑组(P<0.05)。2组均无术中知晓。右美托咪定组芬太尼追加次数少于咪达唑仑组,术后拔管时间短于咪达唑仑组,拔管后15 min OAA/S镇静评分高于咪达唑仑组,VAS评分低于咪达唑仑组(P均<0.05)。结论与咪达唑仑比较,右美托咪定在腹腔镜手术麻醉中具有血流动力学稳定、减少麻醉用药剂量、苏醒快、苏醒质量高等优点。

Objective To compare the anesthetic effects of dexmedetomidine and midazolam during laparoscopic surgery.Methods Selected 50 patients undergoing laparoscopic surgery in the People’s Hospital of Qingxin District,Qingyuan City,Guangdong Province from January 2017 to January 2019,the patients were divided into dexmedetomidine group and midazolam group by random number table method,25 cases in each group.Ten minutes before anesthesia induction,dexmedetomidine group was intravenously injected with dexmedetomidine,midazolam group was given intravenous midazolam.Both groups received fentanyl,propofol and cisatracurium to complete anesthesia induced intubation.Intraoperative anesthesia was maintained by inhalation of sevoflurane,and fentanyl was added based on blood pressure and depth of anesthesia monitoring.The heart rate(HR)and mean arterial pressure(MAP)of the 2 groups before the anesthesia(T0),10 minutes after the anesthesia(T1),1 minute after the intubation(T2),the pneumoperitoneum(T3),and the extubation(T4)were recorded.The fentanyl dosage,extubation time,OAA/S sedation score,VAS score of the two groups were observed.Results Compared with T0,the HR decreased significantly at T1 in the dexmedetomidine group(P<0.05),while HR and MAP increased significantly at T2,T3,and T4 in the midazolam group(P<0.05);the HR of dexmedetomidine group was significantly lower than that of midazolam group at T1,T2,T3,T4(P<0.05).There was no intraoperative knowledge in both groups.The number of fentanyl additions in the dexmedetomidine group was less than that in the midazolam group,the postoperative extubation time was shorter than the midazolam group,and the OAA/S sedation score was higher than the midazolam group,and VAS score was lower than the midazolam group 15 min after extubation(P<0.05).Conclusion Dexmedetomidine has hemodynamic stability compared with midazolam in laparoscopic anesthesia,reducing the anesthetic medication,quick recovery and high quality of recovery.