右美托咪定对氧化亚氮在人工流产中镇痛效应的影响

摘要

目的 研究右美托咪啶(Dex)对氧化亚氮(N2O)在人工流产中镇痛效应的影响.方法 选择门诊自愿要求人工流产终止妊娠的妇女100例(ASA Ⅰ～Ⅱ),分为5组,Dex联合N2O组(D1、D2、D3、D4组)及单纯N2O组(C组),每组20例.D1、D2、D3、D4组分别单次静注Dex 0.2、0.4、0.6、0.8 μg/kg,观察给Dex前,输注Dex后即刻,5 min和 10 min,N2O吸入1 min即刻,人工流产手术开始后1、3 min,人工流产手术结束时手术妇女的SBP、DBP、SpO2、HR、RR、BIS值的变化,并进行RRS镇静评分;手术结束时进行VAS疼痛评分、满意度综合评分,记录可能出现的不良反应.结果 加用Dex后,D1、D2、D3、D4组手术妇女BIS值均低于C组(P＜0.05),D2、D3、D4组手术妇女的RRS镇静评分高于C组(P＜0.05),且与Dex剂量相关;联合用药后手术妇女的VAS疼痛评分明显降低,满意度综合评分显著增加(P＜0.05),其中D2、D3组镇痛效应增强53.5%～65.3%,BIS值与增加N2O吸入浓度无关;D2、D3、D4组出现窦性心动过缓病例数分别为1例(5%)、3例(15%)、5例(25%).结论 应用Dex单次静脉泵注联合50%N2O与50%氧气混合气体面罩吸入有助于提高人工流产手术中的镇静镇痛效果,临床推荐Dex 0.4 μg/kg为联合N2O应用的最佳剂量.%Objective To evaluate the sedative and analgesic efficacy of dexmedetomidine (Dex) combined with nitrous oxide in induced abortion. Methods One hundred women seeking induced abortions were recruited and assigned into 5 groups ( n = 20). Patients in the control group ( C) and the other 4 groups ( D1 , D2, D3 and D4 ) were given intravenous administration of normal saline and Dex of 0. 2, 0. 4, 0. 6 and 0. 8 μg/kg in 10 min, respectively, before inhaling nitrous oxide. SBP, DBP, SpO2, HR, RR, BIS and RRS score were recorded before Dex infusion, and 0 min, 5 min and 10 min after Dex infusion, and 1 min after nitrous oxide inhalation, and at 1 min, 3 min and the ending of the operation. The overall satisfaction and pain score were reported by the patients after the operation and the related complications were recorded. Results The BIS in Group D1 , D2, D3 and D4 were significantly lower than that in Group C ( P＜0. 05 ). Compared with Group C, the RRS scores in Group D2, D3 and D4 were significantly elevated by Dex, following a dose -dependent manner ( P ＜0. 05 ). Pain scores in Group D1, D2, D3 and D4 were significantly lower than that in Group C, and the patients in Group D1, D2, D3 and D4 were significantly more satisfied with the sedative and analgesic effects ( P＜ 0. 05). However, there was no significant correlation between inhalation of nitrous oxide and BIS. One cases (5% ) , three cases (15%) and five cases (25%) of sinus bradycardia were reported in Group D2 , D3 and D4 , respectively. Conclusion The sedative and analgesic effects are improved in Dex combined anesthesia with nitrous oxide in induced a-bortion. We recommend Dex of 0. 4 μg/kg as an optimal dose when using for combined anesthesia with nitrous oxide in clinic.