脑电双频指数监测下不同剂量右美托咪定在妇科腹腔镜手术的应用

摘要

目的 研究不同剂量右美托咪定在妇科腹腔镜手术中的应用效果.方法 选择妇科腹腔镜手术病人120例,随机分成A、B、C三组,A组为安慰剂组(10 ml生理盐水),B组为小剂量右美托咪定组(0.5μg/kg,右美托咪定),C组为大剂量右美托咪定组(1.0μg/kg右美托咪定).记录输注DEX前(T0)、插管前(T1)、切皮前(T2)、切皮后(T3)、术毕(T4)和拔管后(R)的平均动脉压、心率、芬太尼用量,拨管期躁动、呛咳、术后寒颤、恶心呕吐发生率,分析它们是否有差异.结果 T2、T3、T4和T5时间点相比于T1,三组患者的平均动脉压和心率都有明显升高(P＜0.05),但是此时A组患者的平均动脉压和心率略高于T0时刻的值;B组患者的平均动脉压和心率与T0时刻的值相接近;C组患者的平均动脉压和心率低于T0时刻的值.B、C组芬太尼用量都低于A组,但是B组和C组没有明显差异(P＜0.05).B、C组出现拔管期躁动、呛咳、寒战和恶心呕吐的人数也低于A组,同时C组也低于B组(P＜0.05).结论 腹腔镜妇科手术中使用右美托咪定能维持手术期患者血流动力学稳定,减少麻醉药用量,降低麻醉苏醒期副作用的发生率.%Objective To investigate the efficacy of different doses of dexmedetomidine (DEX) for the laparoscopic gynecological surgery.Methods In the study,120 patients scheduled for elective laparoscopic gynecological surgery in our hospital were randomly divided into three groups:group A (10 ml normal saline),group B (0.5 μ g/kg DEX) and group C (1.0 μ g/kg DEX).Mean artery pressure (MAP),heart rate (HR),the doses of remifentanil and the amount of adverse reactions were recorded before being given dexmedetomidine infusion (T0),immediately before tracheal intubation (T1),before and after skin incision (T2-3),at the end of surgery (T4) and after tracheal intubation(T5),and then analyze if there were any significant differences.Results MAP and HR in three groups at the time T2,T3,T4 and T5 were higher than those at the time T1 (P ＜ 0.05).But the MAP and HR in group A at the time T2,T3,T4 and T5 were also higher than those at the time T0 (P ＜ 0.05).The MAP and HR in group B at the time T2,T3,T4 and T5 were substantially equal to those in the time T0.But MAP and HR in group C at the time T2,T3,T4 and T5 were lower than those at the time T0 (P ＜ 0.05).The doses of remifentanil used in B and C groups were lower than those in group A (P ＜ 0.05),but there was no significant different between the doses of remifentanil used in group B and C (P ＞ 0.05).The incidence of cough,dysphonia,chill and vomit in group B and C were lower than those in group A,and the incidence of cough,dysphonia,chill and vomit in group C were also lower than those in group B (P ＜ 0.05).Conclusion DEX could maintain hemodynamic stability,and reduce the using of hardstuff and the incidence of adverse events in surgical.