Narcotrend 监测下右旋美托咪啶复合丙泊酚在无痛人工流产术中的应用效果观察

摘要

Objective To investigate the effect and safety of dexmedetomidine combined with propofol on in-duced abortion under Narcotrend monitoring.Methods Sixty patients with ASA Ⅰ or Ⅱ, undergoing induced abor-tion, were randomly divided into dexmedetomidine group(group D) and propofol group(group P), with 30 cases in each group.The monitoring of anesthesia depth was given in the two groups.After anesthesia induced under Narco-trend monitoring, group D was injected with dexmedetomidine 0.4 μg/kg within 10 min by intravenous injection, and then injected with propofol 2 mg/kg.Group P was injected with propofol 2.5 mg/kg alone, if necessary, propofol was added.The treatment started after NI dropped to set the value of D2(NI =37 ~46), and the medication was added according to whether the NI was in the target range or not.MAP, heart rate(HR) and pulse oxygen saturation(SpO2 ) were recorded at the time points of pre-anesthesia(T0), loss of consciousness(T1), the palace cavity suction(T2) and recovery(T3).The time of recovery and orientation recovery, the dosage of propofol, anesthesia effect and ad-verse reaction were recorded.Results There were no significant differences in the anesthetic effect between the two groups(P >0.05).HR, MAP and SpO2 at T1 were significantly lower than those at T0(P <0.05); MAP and SpO2 decreased more in group P than those in group D(P <0.05), MAP of group P at T2 was lower than that of group D and at T0(P <0.05).The time of awaken and orientation recovery in group P was longer than that in group D(P <0.05).The dosage of propofol in group P was significantly higher than that in group D(P <0.05).Respiratory de-pression, dizziness and restlessness occurrence rate in group P were significantly higher than those in group D(P <0.05).Conclusion Dexmedetomidine combined with propofol in treatment of painless anesthesia can reduce the dose of propofol and adverse effects, make hemodynamics stable and shorten the duration of recovery.%目的：探讨Narcotrend监测下右旋美托咪啶复合异丙酚在无痛人工流产术中的麻醉效果及安全性。方法选取60例 ASA Ⅰ或Ⅱ级行无痛人工流产术患者，随机分为右美托咪啶复合丙泊酚组（D 组）和单纯丙泊酚组（P 组），每组30例。两组患者均接受麻醉深度监测。在 Narcotrend 监测下进行麻醉诱导，D 组10 min 内缓慢静脉注射右美托咪啶0.4μg／kg，再静脉注射丙泊酚2 mg／kg；P 组单独静脉注射丙泊酚2.5 mg／kg，必要时追加丙泊酚。待患者麻醉深度指数（NI）值降至设定值 D2（NI 值37～46）后开始治疗，根据 NI 是否在目标控制范围适当追加用药。分别记录诱导前（T0）、意识消失（T1）、宫腔吸引（T2）、苏醒（T3）时的心率（HR）、血氧饱和度（SpO2）、平均动脉压（MAP），并记录苏醒时间、定向力恢复时间、丙泊酚用量、麻醉效果及不良反应。结果两组麻醉效果差异无统计学意义（P ＞0.05）。 T1时两组 HR、MAP 及 SpO2均低于 T0时（P ＜0.05），其中 MAP 及 SpO2下降幅度 P 组明显大于 D 组（P ＜0.05），T2时 P 组 MAP 显著低于 D 组和 T0时（P ＜0.05）。 P 组苏醒和定向力恢复时间长于 D 组（P ＜0.05），P 组丙泊酚用量明显高于 D 组（P ＜0.05）。术中呼吸抑制、躁动、苏醒时头晕发生率 P 组明显高于 D 组（P ＜0.05）。结论右旋美托咪啶复合丙泊酚应用于无痛人工流产术，能减少丙泊酚的用量及不良反应的发生，使血流动力学更平稳，同时缩短患者恢复时间。