目的 分析右美托咪定联合丙泊酚靶控输注在无痛宫腔镜手术中的剂量选择及围术期不良反应.方法 选取襄阳市妇幼保健院2014至2016年150例行无痛宫腔镜手术患者75例于术前泵注1μg/kg右美托咪定为对照组,75例于术前泵注0.5μg/kg右美托咪定为实验组.两组患者均在12min内结束泵注并全部采用丙泊酚靶控输注保留麻醉,同时按照患者病情适当控制丙泊酚靶控浓度.观察两组患者不同时间点的血流动力学指标,并对比分析两组患者术中、术后疼痛和恶心反胃等不良反应.结果 对比两组患者治疗前、消除肿物时和术毕时的平均动脉压(MAP)均无统计学意义(t值分别-0.98、-0.46、-0.31,均P>0.05),心率(HR)对比亦无统计学意义(t值分别-0.83、-0.53、-1.03,均P>0.05);两组患者在麻醉后、扩宫时的MAP比较,均无统计学意义(t值分别1.21、-0.98,均P>0.05),但实验组患者的HR明显高于对照组(t值分别为6.87、5.63,均P<0.05);实验组术后警觉/镇静评分(OAA/S)明显高于对照组(t=8.96,P=0.00),患者苏醒时间明显较对照组短(t=-7.93,P=0.00)而对比两组的丙泊酚用量,差异并无统计学意义(t=1.07,P=0.11);实验组治疗后嗜睡的发生率远低于对照组(χ2=16.98,P=0.01);两组患者治疗中呼吸受限、术后烦闷、恶心反胃、疼痛不良反应的发生率分别进行对比,均无明显差异(χ2值分别为2.75、1.86、3.04、3.15,均P>0.05).结论 右美托咪定联合丙泊酚靶控输注在无痛宫腔镜手术中应采取小剂量原则,能够减轻丙泊酚用量和副作用,有效减少术后不良反应的出现,安全性、可靠性较高.%Objective To analyze the different doses selection of dexmedetomidine combined with propofol for target controlled infusion in painless hysteroscopic surgery and perioperative adverse reactions .Methods Totally 150 cases undergoing painless hysteroscopic surgery were selected in Maternal and Child Health Hospital of Xiangyang City during 2014 to 2016 and were divided into control group including 75 cases with preoperative infusion of 1μg/kg dexmedetomidine and experiment group including 75 cases with preoperative infusion of 0.5μg/kg dexmedetomidine .The pumping was ended in 12 minutes.Target controlled infusion of propofol anesthesia was used and the concentration was controlled according to patients ' disease.The hemodynamics indexes at different time of two groups were observed and pain, nausea and other adverse reactions were compared between two groups during and after surgery .Results The mean arterial pressure (MAR) in two groups before treatment, eliminating mass and after surgery showed no significant difference (t value was -0.98, -0.46 and -0.31, respectively, all P>0.05), and the heart rate (HR) also showed no significant difference (t value was -0.83, -0.53 and -1.03, respectively, all P>0.05).The MAP of two groups after anesthesia and at uterus dilatation was not significantly different (t value was 1.21 and -0.98, respectively, both P>0.05), but HR in the experiment group was significantly higher than that of the control group (t value was 6.87 and 5.63, respectively, both P<0.05).Observer Assessment of Alertness/Sedation Scale (OAA/S) score in the experimental group after treatment was significantly higher than that of the control group (t=8.96, P=0.00) and the awake time was lower than that of the control group (t=-7.93, P=0.00).But propofol dosage showed no significant difference between two groups (t=1.07, P=0.11).The incidence of sleepiness in the experimental group after treatment was far lower than in the control group (χ2 =16.98,P=0.01).The incidence of respiratory depression during operation , boredom, nausea and pain after treatment between two groups showed no significant difference (χ2 value was 2.75, 1.86, 3.04 and 3.15, respectively, all P>0.05).Conclusion The principle of small dose of dexmedetomidine combined with target controlled infusion of propofol should be adopted in painless hysteroscopic surgery , which can reduce the dosage and side-effects of propofol , effectively reduce the adverse reactions after operation with high safety and reliability.
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