不同剂量右美托咪定对妇科腹腔镜围手术期血流动力学等的影响

目的 通过观察围手术期血流动力学及炎症因子水平变化,探讨不同剂量右美托咪定在妇科腹腔镜手术中的应用.方法 选择2013年6月至2016年4月120例行妇科腹腔镜手术患者,随机分为右美托咪定高剂量组(A1)、右美托咪定低剂量组(A2)及对照组(C),每组40例,A1、A2组分别于麻醉诱导后输注右美托咪定0.8μg·kg-1·h-1、0.4μg·kg-1·h-1,C组给予等量生理盐水,分别于麻醉诱导前10min(T0)、气管插管后1min(T1)、气腹后5 min(T2)、术毕(T3)不同时间点观察各组患者心率(HR)、平均动脉压(MAP)、去甲肾上腺素(NE)及血清IL-6、IL-10、TNF-α水平变化.结果 3组患者在T1、T2时间点MAP、HR、NE均有显著性差异(F值3.23~5.47,均P<0.05),T3时间点HR、NE有显著性差异(F值分别为3.27、3.76,均P<0.05),而MAP无显著性差异(F=1.09,P>0.05),A1在不同时间点MAP、HR、NE均波动最小,C组患者波动最大.3组患者在T1、T2、T3时间点IL-6、IL-10、TNF-α均有显著性差异(F值3.31~5.58,均P<0.05),A1组患者T1、T2、T3时间点IL-6、TNF-α水平均最低,IL-10水平最高,而C组患者IL-6、TNF-6α水平均最高,IL-10水平最低.3组患者气腹时间、麻醉恢复时间均无显著性差异(F值分别为0.559、1.677,均P>0.05).结论 妇科腹腔镜手术中应用右美托咪定可减轻围手术期炎症反应,有利于维持血流动力学稳定,其中0.8μg·kg-1·h-1作用显著.

Effect of different doses of dexmedetomidine on perioperative hemodynamics and inflammatory factors in gynecologic laparoscopic surgery

Objective To explore the effect of different doses of dexmedetomidine on perioperative hemodynamics and inflammatory factors in gynecologic laparoscopic surgery. Methods A total of 120 patients undergoing gynecological laparoscopic surgery during the period of June 2013 to April 2016 were selected and were randomly divided into high dose group (A1), low dose group (A2) and control group (C) with 40 cases in each. Patients in group A1 and group A2 were given 0. 8μg/( kg. h) and 0. 4μg/( kg. h) of dexmedetomidine after induction of anesthesia, respectively. Patients in group C were given saline solution. Heart rate ( HR) , mean arterial pressure ( MAP) , norepinephrine (NE), IL-6, IL-10 and TNF-α in serum were observed in each group at different time points of 10 min before anesthesia (T0), 1 min after tracheal intubation (T1), 5 min after pneumoperitoneum (T2) and the end of the surgery (T3). Results MAP, HR and NE were significantly different among three groups of patients in T1 and T2 ( F value ranged 3. 23 to 5. 47, respectively, all P<0. 05). HR and NE had significant differences (F value was 3. 27 and 3. 76, respectively, both P<0. 05), while there was no significant difference in MAP at T3 (F=1. 09, P>0. 05). MAP, HR and NE waves were minimum in group A1 while most volatile in group C at different time points. Three groups of patients were significantly different at T1, T2 and T3 in IL-6, IL-10 and TNF-α ( F value ranged 3. 31 to 5. 58, respectively, all P<0. 05). At T1, T2 and T3 IL-6 and TNF-αwere lowest but IL-10 was highest in group A1, while IL-6 and TNF-α were highest, but IL-10 was lowest in group C. Three groups of patients were not significantly different in pneumoperitoneum time and anesthesia recovery time (F value was 0. 559 and 1. 677, respectively, both P>0. 05). Conclusion Use of dexmedetomidine in gynecological laparoscopic surgery can reduce the perioperative inflammatory response, which is helpful to maintain hemodynamic stability. The dose of 0. 8μg/(kg. h) is significant.