右美托咪定不同给药方式在腹腔镜卵巢囊肿剔除术超前镇痛中的应用效果

Application Effect of Dexmedetomidine by Different Administration Methods in Preemptive Analgesia during Laparoscopic Ovarian Cystectomy

目的分析右美托咪定(DEX)不同给药方式在腹腔镜卵巢囊肿剔除术超前镇痛中的应用效果。方法选取2019年12月至2021年12月秦皇岛市妇幼保健院收治的121例行腹腔镜卵巢囊肿剔除术的患者作为研究对象,根据DEX不同给药方式分为试验组(61例)和对照组(60例)。两组采用相同的麻醉诱导及维持麻醉方法,其中试验组在麻醉诱导前给予单纯静脉注射0.6μg/kg DEX,15 min内缓慢注射;对照组在麻醉诱导前15 min持续泵注DEX 0.3μg/(kg·h),直至手术完成前20 min。比较两组入室即刻、术毕、拔管时、拔管后10 min、拔管后30 min的心率和平均动脉压(MAP),拔管时间、麻醉恢复室(PACU)停留时间和苏醒时间,拔管后30 min、拔管后1 h、拔管后6 h、拔管后12 h、拔管后24 h的视觉模拟评分法(VAS)评分和Ramasy镇静评分,以及不良反应发生情况。结果心率和MAP组间主效应差异无统计学意义(P>0.05),时点间主效应差异有统计学意义(P<0.01),心率组间与时点间不存在交互作用(P>0.05),MAP组间与时间点存在交互作用(P<0.01);两组不同时间点的心率和MAP变化幅度略有差异,试验组变化幅度较小(P<0.05)。试验组的拔管时间和苏醒时间均短于对照组[(15.3±2.3)min比(22.5±2.4)min、(3.6±0.8)h比(4.6±0.9)h](P<0.01)。VAS评分和Ramasy镇静评分时点间主效应差异有统计学意义(P<0.01),组间与组间和时点间差异无统计学意义(P>0.05);不同时间点两组的VAS评分均呈先升高后降低趋势,Ramasy镇静评分均呈升高趋势(P<0.05)。试验组的总不良反应发生率低于对照组[9.84%(6/61)比25.00%(15/60)](P<0.05)。结论在腹腔镜卵巢囊肿剔除术超前镇痛中,单次静脉注射与持续泵注DEX的给药方法均可得到较好的效果,但单次静脉注射DEX更有利于维持患者血流动力学的稳定性,拔管时间和苏醒时间明显缩短,且用药安全性较好。

Objective To analyze the application effect of dexmedetomidine(DEX)by different administration methods in preemptive analgesia during laparoscopic ovarian cystectomy.Methods A total of 121 patients undergoing laparoscopic ovarian cystectomy admitted to Maternity and Child Care Center of Qinhuangdao from Dec.2019 to Dec.2021 were included,and were divided into a trial group(61 cases)and a control group(60 cases)according to different DEX administration methods.The two groups were given the same anesthesia induction and maintenance methods.The trial group was given simple intravenous injection of 0.6μg/kg DEX before anesthesia induction and slowly injected within 15 min.The control group was continuously injected with DEX 0.3μg/(kg·h)15 min before anesthesia induction until 20 min before the completion of the surgery.The heart rate,mean arterial pressure(MAP),extubation time,postanesthesia care unit(PACU)residence time and recovery time of the two groups were compared immediately after admission,after surgery,at extubation,10 min and 30 min after extubation.Visual analogue scale(VAS)score and Ramasy sedation score were obtained and compared 30 min,1 h,6 h,12 h and 24 h after extubation,as well as the occurrence of adverse reactions.Results Regarding heart rate and MAP,there was no statistically significant difference in the main effect between groups(P>0.05),there was significant difference in the main effect between time points(P<0.01);there was no interaction between groups and time points regarding heart rate(P>0.05),there was interaction between groups and time points regarding MAP(P<0.01).The change amplitude of heart rate and MAP at different time points was slightly different between the two groups,and the change amplitude of the trial group was smaller(P<0.05).The extubation time and recovery time of the trial group were shorter than that of the control group[(15.3±2.3)min vs(22.5±2.4)min,(3.6±0.8)h vs(4.6±0.9)h](P<0.01).The main effect differences of VAS score and Ramasy score were statistically significant between time points(P<0.01),while there was no statistically significant difference between groups or between groups and time points(P>0.05).At different time points,the VAS scores of both groups showed a trend of first increasing and then decreasing,while the Ramasy sedation scores showed an increasing trend(P<0.05).The total incidence of adverse reactions in the trial group was lower than that in the control group[9.84%(6/61)vs 25.00%(15/60)](P<0.05).Conclusion In the preemptive analgesia of laparoscopic ovarian cystectomy,both single intravenous injection and continuous pump injection of DEX can achieve good results,but single intravenous injection of DEX is more conducive to maintaining the stability of hemodynamics in the patients,significantly shortening the extubation time and recovery time,and has good drug safety.