右美托咪定在子宫肌瘤剔除术中的应用分析

Application of dexmedetomidine in myomectomy

目的分析右美托咪定在子宫肌瘤剔除术中的应用效果。方法收集2020年3月至2021年3月在上海中医药大学附属曙光医院就诊的56例子宫肌瘤剔除术患者,按不同麻醉用药分为两组,对照组27例在麻醉诱导前静脉注射0.9%氯化钠注射液1μg/kg,麻醉中以0.3μg·kg^(-1)·h^(-1)静脉滴注至术毕;研究组29例在麻醉诱导前静脉注射右美托咪定1μg/kg,麻醉中以0.3μg·kg^(-1)·h^(-1)静脉滴注至术毕。比较两组麻醉效果、机械痛觉阈值、应激指标及血流动力学指标,并进行统计分析。结果研究组的麻醉苏醒时间、自主呼吸恢复时间、呼之睁眼时间均显著短于对照组(t值分别为5.928、4.610、7.386,P<0.05)。术前两组的机械痛觉阈值比较差异无统计学意义(P>0.05),而术后6h、12h、24h,研究组的机械痛觉阈值均显著大于对照组(t值分别为10.085、10.277、9.140,P<0.05)。麻醉前15min(T0)时,研究组的去甲肾上腺素(NE)、皮质醇(COR)与对照组比较差异均无统计学意义(P>0.05);插管后5min(T1)、术毕(T2)、术后24h(T3)时,研究组的NE、COR均显著低于对照组(t值分别为2.784、9.403、2.149、4.365、17.941、15.339,P<0.05)。T0、T3时,研究组的心率、平均动脉压(MAP)与对照组比较差异均无统计学意义(P>0.05);而T1、T2时,研究组的心率、MAP均显著低于对照组(t值分别为9.047、16.632、4.067、10.955,P<0.05)。结论右美托咪定联合丙泊酚全身麻醉用于子宫肌瘤剔除术能取得较好的麻醉效果,升高机械痛觉阈值,减轻应激反应,且能维持血流动力学稳定。

Objective To analyze the effect of dexmedetomidine in myomectomy.Methods From March 2020to March 2021,56pa-tients treated with myomectomy in Shuguang hospital,Shanghai University of traditional Chinese medicine were divided into two groups according to the different anesthetic drugs.The 27cases in the control group were injected intravenously with 0.9%sodium chloride injection 1μg/kg before the induction of anesthesia,and 0.3μg·kg^(-1)·h^(-1) was infused intravenously during the anesthesia until the end of the operation.The 29cases in the study group were injected intravenously with dexmedetomidine 1μg/kg before the induction of anesthesia,and inject 0.3μg·kg^(-1)·h^(-1) intravenously during the anesthesia until the end of the operation.The anes-thesia effect,mechanical pain threshold,stress indicators and hemodynamics parameters were compared and analyzed between the two groups.Results The awakening time from anesthesia,autonomous breathing recovery time,and the blink time of eyes of the study group were significantly shorter than those of the control group(t=5.928,4.610,and 7.386,respectively,P<0.05).There was no significant difference in mechanical pain threshold between the two groups before operation(P>0.05),the mechanical pain threshold of the study group at 6h,12h,and 24hafter operation were significantly greater than those of the control group(t=10.085,10.277,and 9.140,respectively,P<0.05).At 15min(T0)before anesthesia,there was no significant difference in norepi-nephrine(NE)and cortisol(COR)between the two groups(P>0.05).At T1(5min after intubation),T2(end of operation),and T3(24hafter operation),the NE and COR in the study group were lower than those in the control group(t_(NE)=2.784,9.403,and 2.149,respectively,P<0.05;t_(COR)=4.365,17.941,and 15.339,respectively,P<0.05).At T0and T3,there was no significant difference in heart rate(HR)and mean arterial pressure(MAP)between the two groups(P>0.05).At T1and T2,the HR and MAP of the study group were lower than those of the control group(t_(HR)=9.047and 16.632,respectively,P<0.05;t_(MAP)=4.067 and 10.955,respectively,P<0.05).Conclusion Dexmedetomidine combined with propofol general anesthesia for myomectomy can achieve better anesthesia effects,increase the mechanical pain threshold,reduce stress reactions,and maintain hemodynamic stability.