右美托咪定不同时间给药对腹腔镜手术患者麻醉效果、术后复苏质量的影响

Effects of Dexmedetomidine Administration at Different Times on Anesthetic Effect and Postoperative Resuscitation Quality in Laparoscopic Surgery

目的:右美托咪定不同时间给药对腹腔镜手术患者麻醉效果、术后复苏质量的影响分析。方法:选取2020年1月—2021年12月灌云县人民医院70例行腹腔镜手术的患者作为研究对象,遵循抽签法原则,分为对照组(n=35)和观察组(n=35)。对照组于手术结束前15 min给予右美托咪定,观察组于诱导前15 min泵注右美托咪定,对比两组患者麻醉效果(术后苏醒时间、自主呼吸恢复时间、拔管时间),不同时间点[麻醉诱导前(T_(1))、气管插管即刻(T_(2))、导管拔除即刻(T_(3))]、血流动力学[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))]、苏醒即刻、术后1 d、术后3 d疼痛程度(VAS)、镇静(Ramsay)评分。结果:观察组术后苏醒时间、自主呼吸恢复时间、拔管时间较对照组更短,差异有统计学意义(t=2.505、2.108、3.864,P<0.05);T_(1)~T_(3)时,两组患者HR、MAP呈先降低再升高趋势,且观察组变化幅度更小,差异有统计学意义(t=0.342、6.634、8.575;t=0.750、4.139、7.301,P<0.05);术后1 d、3 d,观察组VAS、Ramsay评分较对照组更低,差异有统计学意义(t=2.225、4.146;t=5.599、5.040,P<0.05)。结论:诱导前15 min给予患者右美托咪定麻醉效果更好,可促进术后尽快苏醒,稳定血流动力学,镇痛、镇静效果明显。

Objective:To analyze the influence of dexmedetomidine administration at different times on the anesthetic effect and postoperative resuscitation quality in laparoscopic surgery.Methods:A total of 70 patients who underwent laparoscopic surgery in the hospital from January 2020 to December 2021 were selected and divided into control group(n=35)and observation group(n=35)according to the principle of lottery method.The control group was given dexmedetomidine 15 min before the end of surgery,while the observation group was given dexmedetomidine.Dexmedetomidine was pumped 15 min before induction.Anesthetic effects(postoperative recovery time,spontaneous breathing recovery time and extubation time)were compared between the two groups.Hemodynamics[heart rate(HR),arterial pressure(MAP),oxygen saturation(SpO_(2))]at different time points[before anesthesia induction(T_(1)),immediately after endotracheal intubation(T_(2)),immediately after catheter removal(T_(3))],immediate recovery,postoperative pain(VAS),sedation(Ramsay)score 1 day and 3 days after surgery were compared.Results:Compared with the control group,the recovery time,spontaneous breathing recovery time and extubation time of the observation group were shorter(t=2.505,2.108,3.864;P<0.05).At T_(1)~T_(3),HR and MAP in the two groups decreased first and then increased,and the change range in the observation group was smaller,with statistically significant difference(t=0.342,6.634,8.575;t=0.750,4.139,7.301;P<0.05).1 day and 3 days after operation,the scores of VAS and Ramsay in the observation group were lower than those of the control group(t=2.225,4.146;t=5.599,5.040;P<0.05).Conclusion:Dexmedetomidine 15 min before induction has better anesthetic effect,which can promote postoperative recovery as soon as possible,stabilize hemodynamics,and have obvious analgesic and sedative effects.