不同剂量右美托咪定对宫颈癌手术患者的麻醉效果及安全性

Anesthetic effect and safety of different doses of dexmedetomidine in patients undergoing cervical cancer surgery

目的探讨不同剂量右美托咪定对宫颈癌手术患者的麻醉效果及安全性。方法依据腹腔镜宫颈癌根治术术中右美托咪定应用剂量将92例宫颈癌患者分为低剂量组和高剂量组,每组46例,低剂量组患者术中右美托咪定应用剂量为0.5μg/kg,高剂量组患者术中右美托咪定应用剂量为1.0μg/kg。比较两组患者围手术期心率和中心动脉压(MAP)水平、Ramsay镇静评分、麻醉不良反应发生情况、麻醉药物用量和苏醒质量。结果高剂量组患者麻醉诱导后10 min(T1)、术毕即刻(T3)时的心率均低于低剂量组患者,高剂量组患者T1时的MAP低于低剂量组患者,差异均有统计学意义(P﹤0.05)。T1时,两组患者的心率、MAP均降至低点,建立气腹后5 min(T2)、T3时有所回升。诱导前15 min或右美托咪定注射前(T0)、T1时,两组患者的Ramsay评分比较,差异均无统计学意义(P﹥0.05);术后2 h(T4),低剂量组患者的Ramsay评分明显低于高剂量组患者,差异有统计学意义(P﹤0.01)。低剂量组患者术中不良反应总发生率为2.17%,低于高剂量组患者的15.22%,差异有统计学意义(P﹤0.05)。两组患者术中芬太尼、丙泊酚用量比较,差异均无统计学意义(P﹥0.05)。低剂量组患者苏醒时间、拔管时间、应答时间均明显短于高剂量组患者,差异均有统计学意义(P﹤0.01)。结论低剂量右美托咪定用于腹腔镜宫颈癌手术中,可实现与高剂量相似的麻醉效果,不会增加麻醉药物的使用剂量,且可更好的维持患者术中生命体征平稳,提高手术的麻醉安全性,有利于改善患者术后的苏醒质量。

Objective To study the efficacy and safety of different doses of dexmedetomidine in surgical anesthesia for cervical cancer.Method According to the dosage of dexmedetomidine used in laparoscopic radical hysterectomy,92 patients with cervical cancer were divided into low-dose group and high dose group,46 cases in each group.The intraoperative anesthetic dose of low-dose group was 0.5μg/kg,while that of high-dose group was 1.0μg/kg.The perioperative heart rate(HR),mean arterial pressure(MAP),Ramsay sedation score,adverse reactions,dosage of anesthetic and quality of recovery were compared between the two groups.Result HR of the high-dose group at 10 min(T1)and immediately after surgery(T3)was lower than that of the low-dose group,and MAP of the high-dose group at T1 was higher than that of the low-dose group(P<0.05).The HR and MAP of the two groups at T1 decreased to a low point,and then increased at 5 min(T2)and T3 after the establishment of pneumoperitoneum.There was no significant difference in Ramsay score between the two groups 15 min before induction or before dexmedetomidine injection(T0),T1,the difference was statistically significant(P>0.05),but the Ramsay scores of the low-dose group 2 h after surgery(T4)were lower than those of the high-dose group(P<0.01).The incidence of adverse reactions in the low-dose group was 2.17%,which was lower than 15.22%in the high-dose group(P<0.05).There was no significant difference in intraoperative fentanyl and propofol dosage between the two groups(P>0.05).The quality indicators of wake time,extubation time and response time in the lowdose group were all lower than those in the high-dose group(P<0.01).Conclusion Low dose dexmedetomidine can achieve similar anesthetic effect as high dose dexmedetomidine in laparoscopic cervical cancer surgery.It does not increase the dosage of narcotic drugs,and can better maintain the stability of patients’vital signs,improve the safety of anesthesia,and is conducive to improving the quality of postoperative recovery.