布托啡诺联合右美托咪定对腹腔镜下子宫肌瘤剔除术患者血流变和应激反应的影响

Influence of butorphanol combined with dexmedetomidine for anesthesia induction of patients during laparoscopic myomectomy on their hemorheology and stress response

目的:探讨腹腔镜下子宫肌瘤剔除术布托啡诺联合右美托咪定对患者血流变学、内皮素-1(ET-1)及血管紧张素Ⅱ(AngⅡ)水平的影响。方法:选取2020年1月-2020年12月本院收治的腹腔镜子宫肌瘤剔除术患者182例,随机数字表法分为观察组和对照组各91例。麻醉诱导前15min观察组给予右美托咪定注射液(0.5μg/kg)+麻醉诱导时布托啡诺注射液(0.02mg/kg),对照组麻给予右美托咪定注射液(0.5μg/kg)+麻醉诱导时与布托啡诺注射液等量的生理盐水。比较两组入室时(T0)、麻醉诱导后(T1)、手术30min(T2)、术后2h(T3)的ET-1、Ang-Ⅱ、全血比粘度、血浆粘度、纤维蛋白原水平。结果:观察组T1、T2、T3时刻血浆粘度、全血比粘度低于T0时刻,T1时刻纤维蛋白原高于T0、T2、T3时刻(均P<0.05);T1、T2、T3时刻观察组血浆粘度低于对照组,T1、T2时刻观察组全血比粘度低于对照组,T1时刻观察组纤维蛋白原高于对照组(均P<0.05)。ET-1、Ang-II水平随着T0~T3时间的延长两组均呈升高趋势,T1、T2、T3时刻观察组均低于对照组(均P<0.05)。观察组不良反应发生率(25.3%)低于对照组(39.6%)(P<0.05)。结论:腹腔镜下子宫肌瘤剔除术布托啡诺联合右美托咪定可减轻对患者血流变学影响,抑制ET-1、AngⅡ水平升高,减少术后麻醉相关不良反应。

Objective: To investigate the influence of bupropion combined with dexmedetomidine for anesthesia induction of patients during laparoscopic myomectomy on their hemorheology and the levels of their endothelin-1(ET-1) and angiotensin Ⅱ(Ang Ⅱ). Methods: 182 patients who wanted laparoscopic myomectomy were selected and simply randomly divided into two groups(91 cases in each group) by the random number table method from January 2020 to December 2020. At 15 min before anesthesia induction, the patients in the observation group were given dexmedetomidine injection(0.5 μg/kg) combined with bupropion injection(0.02 mg/kg), and the patients in the control group were given dexmedetomidine injection(0.5 μg/kg) combined with normal saline(equal amount of bupropion). The levels of ET-1, Ang-Ⅱ, and fibrinogen, and the values of whole blood specific viscosity, plasma viscosity of the patients at the time of entering room(T0), after induction of anesthesia(T1), 30 min after surgery(T2), and 2 h after surgery(T3) of the patients were compared between the two groups. Results: The values of plasma viscosity and whole blood specific viscosity of the patients in the observation group at T1, T2, and T3 were significantly lower than those at T0, and the fibrinogen level of the patients in the observation group at T1 was significantly higher than those at T0, T2, and T3(all P<0.05). The plasma viscosity value of the patients in the observation group at T1, T2, and T3 was significantly lower than that of the patients in the control group, the value of whole blood specific viscosity of the patients in the observation group at T1 and T2 was significantly lower than that of the patients in the control group, and the value of plasma viscosity of the patients in the observation group at T1was significantly higher than that of the patients in the control group(all P<0.05).The levels of ET-1and ANG-Ⅱ of the patients in the two groups at T0,T1,T2,and T3had increased gradually,which of the patients in the observation group at T1,T2,and T3was significantly lower than that of the patients in the control group(all P<0.05).The incidence of adverse reactions(25.3%)of the patients in observation group was significantly lower than that(39.6%)of the patients in control group(P<0.05).Conclusion:Butorphanol combined with dexmedetomidine for anesthesia induction of patients during laparoscopic myomectomy can reduce the adverse influences on their hemodynamics,which can inhibit the increase of ET-1and Ang Ⅱ levels,and can decrease the occurrence of postoperative anesthesia-related adverse reactions.