右美托咪定对腹腔镜子宫肌瘤剔除术患者疼痛及血流动力学的影响

Effects of dexmedetomidine on pain and hemodynamics in patients undergoing laparoscopic myomectomy

目的探讨右美托咪定对腹腔镜子宫肌瘤剔除术(laparoscopic myomectomy,LM)患者疼痛及血流动力学的影响。方法回顾性选取兵器工业五二一医院2020年1月至2022年12月收治的行LM的患者104例作为研究对象,依据麻醉方式分为观察组(52例)和对照组(52例)。对照组给予舒芬太尼,观察组在对照组基础上给予右美托咪定,两组均于术后随访并观察3 d。比较两组术前(T0)及术后24 h(T5)的睡眠质量,不同时点的应激指标、机械痛觉阈值、认知功能、血流动力学水平,术后3 d不良反应发生情况。结果两组匹兹堡睡眠质量量表(PSQI)各项评分在T5相比于T0均升高,且对照组高于观察组(P<0.05);两组血清白细胞介素-6(interleukin-6,IL-6)、去甲肾上腺素(norepinephrine,NE)、丙二醛(malondialdehyde,MDA)在手术30 min(T2)、T5的水平相比于T0先升高后降低,血清血管紧张素-Ⅱ(angiotensin-Ⅱ,Ang-Ⅱ)在T2、T5的水平相比于T0持续升高,且对照组在T2、T5的血清IL-6、NE、MDA、Ang-Ⅱ水平均高于观察组(P<0.05);两组机械痛觉阈值、简易精神状态量表(Mini-Mental State Examination,MMSE)评分在术后12 h(T4)、T5相比于T0先降低后升高,且对照组在T4和T5低于观察组(P<0.05);两组心率(HR)、平均动脉压(mean arterial pressure,MAP)在气管插管5 min(T1)、T2、手术结束时(T3)的水平相比于T0逐渐升高,且对照组在T1、T2、T3的水平高于观察组(P<0.05);两组心脏指数(CI)在T1、T2、T3的水平相比于T0先降低后升高,且对照组在T1、T2、T3的CI水平低于观察组(P<0.05);两组中心静脉压(central venous pressure,CVP)在T1、T2、T3的水平相比于T0逐渐降低,且对照组在T3的CVP水平高于观察组(P<0.05);两组术后3 d内不良反应发生情况相比,观察组低于对照组(P<0.05)。结论LM患者采用右美托咪定麻醉,对于睡眠质量、认知功能、血流动力学影响较小,可减轻机体应激反应,提升机械痛觉阈值,且不良反应较小,具有一定的安全性。

Objective To investigate the effects of dexmedetomidine on pain and hemodynamics in patients undergoing laparoscopic myomectomy(LM).Methods A total of 104 patients with LM admitted to 521 Hospital of Nornico Group Xi'an from January 2020 to December 2022 were retrospectively selected as the study objects,and were divided into the observation group(52 cases)and the control group(52 cases)according to different anesthesia methods.The control group was given Sufentanil,and the observation group was given dexmedetomidine on the basis of the control group.Both groups were followed up and observed for 3 d after surgery.Sleep quality of before surgery(T0)and 24 h after surgery(T5),and the level of stress index,mechanical pain threshold,cognitive function,hemodynamic at different time points,and the occurrence of adverse reactions at 3 d after surgery were compared between the two groups.Results The scores of Pittsburgh Sleep Quality Inventory(PSQI)in both groups were higher in T5 than T0 in both groups,and the control group was higher than the observation group(P<0.05).The level of serum interleukin-6(IL-6),norepinephrine(NE)and malondialdehyde(MDA)in the two groups at anesthesia for 30 min(T2),T5 firstly increased and then decreased compared with T0,while the level of serum angiotensin-Ⅱ(Ang-Ⅱ)at T2,T5 increased compared with T0,and the level of serum IL-6,NE,MDA and Ang-Ⅱin T2 and T5 of the control group were higher than those of the observation group(P<0.05).The mechanical pain threshold and the score of Mini-Mental State Examination(MMSE)in the two groups at 12 h after surgery(T4),T5 firstly decreased and then increased compared with T0,and the control group was lower than the observation group at T4 and T5(P<0.05).The level of heart rate(HR)and blood mean arterial pressure(MAP)in the two groups at endotracheal intubation for 5 min(T1),T2,after surgery(T3)showed a gradually increasing trend compared with that at T0,and the levels of the control group at T1,T2,and T3 were higher than those of the observation group(P<0.05).The level of cardiac index(CI)in the two groups at T1,T2,T3 firstly decreased and then increased compared with that at T0,and the levels of CI in the control group at T1,T2,and T3 were lower than that of the observation group(P<0.05).The level of central venous pressure(CVP)in the two groups at T1,T2,T3 decreased compared with that at T0,the level of CVP in the control group at T3 was higher than that of the observation group(P<0.05).The occurrence of adverse reactions within 3 d after surgery in the observation group was lower than that in the control group(P<0.05).Conclusion Patients with LM anesthetied with dexmedetomidine had little effect on sleep quality,cognitive function and hemodynamics,and could reduce the body's stress response,improve the mechanical pain threshold,and had less adverse reactions,with certain safety.