右美托咪啶辅助全麻在妇科腹腔镜手术中的应用

目的研究右美托咪啶辅助全身麻醉在妇科腹腔镜手术中的应用。方法择期行妇科腹腔镜手术患者60例,ASA分级Ⅰ~Ⅱ级。随机分为两组:右美托咪啶组(D组)和对照组(C组),每组30例。D组患者在麻醉诱导前静脉泵注右美托咪啶0.5μg·kg-1(10 min泵注完毕),术中继以0.4μg·kg-1·h-1持续泵注;对照组以同样方式泵注等量0.9%氯化钠。记录两组患者给药前(T0)、插管即刻(T1)、手术开始即刻(T2)、气腹10 min(T3)、拔管即刻(T4)的平均动脉压(MAP)和心率(HR)。记录两组手术时间、麻醉时间、苏醒时间、拔管时间及拔管呛咳反应和苏醒期躁动情况。结果两组手术时间、麻醉时间、苏醒时间、拔管时间比较差异无统计学意义;D组在T1、T2、T3和T4点的MAP、HR低于同时点对照组(P<0.05)。C组T1~4各时间点MAP、HR均较T0时升高(P<0.05)。D组拔管呛咳反应和苏醒期躁动的发生率较C组明显减少(P<0.05)。结论麻醉诱导前静脉泵注右美托咪啶0.5μg·kg-1(10 min泵注完毕),术中继以0.4μg·kg-1·h-1持续泵注可减轻妇科患者腹腔镜手术中循环动力学反应,降低拔管呛咳及苏醒期躁动发生率,从而提高麻醉质量。

Application of dexmedetomidine as an adjunct in general anesthesia for patients undergoing gynecological laparoscopy

Objective To study the effect of dexmedetomidine as an adjunct in general anesthesia for patients undergoing gynecological laparoscopy.Methods Sixty ASAⅠ -Ⅱ patients undergoing gynecological laparoscopy were randomly assigned into two groups：dexmedetomidine group （group D）and control group （group C）with 30 each.Dexmedetomidine was infused with a bolus of 0.5 μg· kg^-1 （infused more than 1 0 min）before anesthesia induction in group D,followed by 0.4 μg·kg^-1 ·h^-1 continuous infusion.0.9%sodium chloride was infused in the same way in control group.MAP and HR were recorded at the time points of pre-administration of dexmedetomidine （T0 ）,immediately after intubation （T1 ）,after incision （T2 ）,1 0 min after aeroperitioneum （T3 ）,immediately af-ter extubation （T4 ）.The following variables were also recorded：surgery time,anesthesia time,emergence and extubation time,cough response and restlessness rate.Results There were no significant differences between two groups in surgery time,anesthesia time,e-mergence time and extubation time.MAP,HR in group D were lower than those in control group immediately after intubation （T1 ）, after incision （T2 ）,1 0min after aeroperitioneum （T3 ）,immediately after extubation （T4 ）（P〈0.05 ）.Compared with those at T0, MAP and HR were significantly increased at T1 ~4 in group C（P〈0.05）.The rates of cough response and restlessness in group D were lower than those in control group（P〈0.05 ）.Conclusions Dexmedetomidine infused with a bolus of 0.5 μg·kg^-1 （infused more than 1 0min）before anesthesia induction,followed by 0.4 μg·kg^-1 · h^-1 continuous infusion can effectively diminish the patients’ fluctuation of hemodynamics and reduce the rate of patients’cough response and recovery restlessness.It is beneficial to general anesthesia in patients undergoing gynecological laparoscopy.