丙泊酚复合右美托咪定对腹腔镜子宫肌瘤切除术后患者疼痛及应激反应的影响

Effects of propofol combined with dexmedetomidine used during laparoscopic myomectomy of patients on their postoperative pain and stress response

目的:分析丙泊酚复合右美托咪定对腹腔镜子宫肌瘤切除术后患者疼痛、应激反应的影响。方法:将2021年1月-2023年12月本院拟行腹腔镜子宫肌瘤切除术患者92例随机分为两组各46例,分别予以丙泊酚复合舒芬太尼进行麻醉维持(对照组)或丙泊酚复合右美托咪定进行麻醉维持(观察组),比较两组术后疼痛程度(VAS评分)、认知功能(MMSE评分)、应激反应指标皮质醇(Cor)、炎性因子白介素-6(IL-6)、不良反应(恶心呕吐、低氧血症、呼吸抑制、躁动)。结果:观察组术后2、6、12、24h的VAS评分(2.91±0.52分、2.51±0.50分、2.06±0.43分、1.73±0.35分)均低于对照组(3.59±0.60分、3.06±0.57分、2.40±0.47分、2.10±0.40分),两组术后24h MMSE评分均低于术前但观察组(27.80±1.11分)高于对照组(26.74±1.08分),术后24h血清Cor、IL-6均高于术前但观察组(16.29±3.29 mmol/L、78.39±6.72 pg/ml)均低于对照组(20.46±3.40 mmol/L、86.35±6.11 pg/ml),不良反应总发生率观察组(4.4%)低于对照组(17.4%)(均P<0.05)。结论:丙泊酚复合右美托咪定在腹腔镜子宫肌瘤切除术中应用效果较好,可减轻患者疼痛及认知功能损伤,改善应激反应指标与炎性因子水平,且不良反应少,用药安全。

Objective:To analyze the effects of propofol combined with dexmedetomidine used during laparoscopic myomectomy of patients on their postoperative pain and stress response.Methods:92 patients who wanted laparoscopic myomectomy were randomly assigned to two groups from January 2021 to December 2023.46 patients in control group received propofol combined with sufentanil for anesthesia maintenance,while 46 patients in observation group received propofol combined with dexmedetomidine for anesthesia maintenance.The postoperative pain degree evaluated by VAS score,the cognitive function evaluated by MMSE score,the levels of stress response of cortisol(Cor) and inflammatory factor of cytokine-6(IL-6),and rates of adverse reactions,such as nausea and vomiting,hypoxemia,respiratory depression and restlessness,of the patients were compared between the two groups.Results:The VAS scores of the patients in the observation group at 2 h,6 h,12 h and 24 h after operation(2.91±0.52 points,2.51±0.50 points,2.06±0.43 points and 1.73±0.35 points) were significantly lower than those(3.59±0.60 points,3.06±0.57 points,2.40±0.47 points and 2.10±0.40 points) of the patients in the control group.The MMSE score of the patients in the two groups at 24 h after operation had decreased significantly,and which(27.80±1.11 points) of the patients in the observation group was significantly higher than that(26.74±1.08 points) of the patients in the control group.The serum levels of Cor and IL-6 of the patients in the two groups at 24 h after operation had increased significantly,and which(16.29±3.29 mmol/L and 78.39±6.72 pg/ml) of the patients in the observation group were significantly lower than those(20.46±3.40 mmol/L and 86.35±6.11 pg/ml) of the patients in the control group.The total incidence of adverse reactions(4.4%) of the patients in the observation group was significantly lower than that(17.4%) of the patients in the control group(all P<0.05).Conclusion:The combination of propofol and dexmedetomidine used during laparoscopic myomectomy of the patients has good anesthetic effect,which can reduce the pain degree and cognitive impairment of the patients,improve the stress response indicators and inflammatory factor levels of the patients,and has fewer adverse reactions and better medicine safety.