右美托咪定鞘内联合罗哌卡因在宫腔镜术中的镇痛镇静效果

Analgesic and sedation effect of dexmedetomidine intrathecal combined with ropivacaine for patients during hysteroscopic surgery

目的:比较右美托咪定与芬太尼鞘内复合罗哌卡因在宫腔镜手术中的麻醉效果和不良反应。方法:选择2019年9月—2022年4月本院择期行妇科宫腔镜手术治疗的92例患者临床资料,根据使用麻醉药物不同分组,对照组(30例)7.5 mg罗哌卡因、复合1组(30例)7.5 mg罗哌卡因+5μg右美托咪定、复合2组(32例)7.5 mg罗哌卡因+15μg芬太尼蛛网膜下腔给药。记录各组感觉和运动阻滞的起效时间、持续时间;术后疼痛评分、镇静评分及不良反应。结果:复合1组与复合2组感觉和运动阻滞起效时间无差异但均小于对照组。复合1组感觉阻滞持续时间(191.25±35.28min)长于复合2组(149.86±33.97min)和对照组(139.44±25.21min)(P<0.05),运动阻滞时间3组无差异(P>0.05)。手术开始10min、手术结束和手术结束10min复合1组Ramsay镇静评分均优于对照组和复合2组(均P<0.05)。术后6h、12h VAS复合1组(0.31±0.14分,2.05±0.87分)均低于对照组(1.35±0.52分,4.25±1.22分)和复合2组(0.79±0.33分,3.11±1.04分)(均P<0.05)。复合2组发生2例(6.3%)心动过缓,不良反应总发生率(46.9%)高于对照组(13.3%)和复合1组(16.7%)(P<0.05)。结论:与芬太尼相比,右美托咪定鞘内复合罗哌卡因在宫腔镜手术中镇静镇痛效果更好,不良反应更少,安全性更高。

Objective:To compare the analgesic effect and adverse reactions of ropivacaine combined with dexmedetomidine or fentanyl during hysteroscopic surgery.Methods:A retrospective analysis was performed on 92patients who underwent gynecological hysteroscopy elective surgery between September 2019and April 2022.According to the different anesthesia drugs used,these patients were divided into group A(30patients with 7.5mg ropivacaine administered in subarachnoid space),group B(30patients with 7.5mg ropivacaine combined with 5μg dexmedetomidine in subarachnoid space),and group C(32patients with 7.5mg ropivacaine combined with15μg fentanyl in subarachnoid space).The onset time of sensory and motor block,the maintain time of sensory and motor block,the postoperative pain score,the sedation score,and the adverse reactions situation of the patients were recorded.Results:There were no significant differences in the onset time of sensory and motor block of the patients between group B and group C,but which of the patients in group B and group C were significantly shorter than those of the patients in group A.The duration of sensory block(191.25±35.28min)of the patients in group B was significantly longer than that(149.86±33.97min)of the patients in group C and that(139.44±25.21min)of the patients in group A(P<0.05).There was no significant difference in the motor block duration of the patients among the three groups(P>0.05).The Ramsay sedation score of the patients in group B was significantly higher than that of the patients in group A and that of the patients in group C(all P<0.05).The VAS score of the patients in group B in postoperative 6hand 12h(0.31±0.14and 2.05±0.87)were significantly lower than those(1.35±0.52and 4.25±1.22)of the patients in group A and those(0.79±0.33and 3.11±1.04)of the patients in group C(P<0.05).There were 2(6.3%)patients with bradycardia occurred in group C,and the overall incidence of adverse reactions(46.9%)of the patients in group C was significantly higher than that(13.3%)of the patients in group A and that(16.7%)of the patients in group B(P<0.05).Conclusion:Compared with those of fentanyl,dexmedetomidine combined with ropivacaine used in hysteroscopic surgery has better sedative and analgesic effect,and with less adverse reactions and higher safety.