右美托咪定对腹腔镜全子宫切除手术患者全身麻醉苏醒期血流动力学指标及苏醒质量的影响

摘要

目的：观察术中应用右美托咪定对腹腔镜全子宫切除手术患者全身麻醉苏醒期血流动力学指标及苏醒质量的影响。方法选择全麻择期行腹腔镜全子宫切除的手术患者60例,年龄43~60岁,体重45~77 kg,ASA Ⅰ~Ⅱ级,随机分为2组,右美托咪定组30例,麻醉诱导前10 min泵注负荷量右美托咪定0.5μg/kg,然后持续泵入维持量0.2μg·kg-1·h-1,手术结束前40 min停药；对照组30例,给予等容量的0.9%氯化钠溶液。记录麻醉前(T0)、拔管时(T1)、拔管后10 min(T2)各时点的血流动力学指标(HR、SBP、MAP),并记录全身麻醉苏醒质量相关指标,包括拔管呛咳、躁动、寒颤、在术后苏醒室的停留时间。结果术中应用右美托咪定可显著提高腹腔镜全子宫切除术患者苏醒质量。与对照组相比,右美托咪定组苏醒期各时点血流动力学指标( HR、SBP、MAP)以及拔管呛咳、躁动、寒颤的发生差异有统计学意义( P <0.05),在术后苏醒室的停留时间差异无统计学意义( P >0.05),2组患者均无呼吸抑制发生。结论右美托咪定用于腹腔镜全子宫切除手术患者,拔管期的心血管反应更小,血流动力学更稳定,拔管呛咳发生率低,有效降低术后苏醒期躁动、寒颤的发生率,有利于患者平稳舒适的度过苏醒期,不延长在术后苏醒室的停留时间,可作为临床应用的可行方案。%Objective To observe the effects of intraoperative application of dexmedetomidine on hemodynamic indexes and analepsia quality at analepsia period during general anesthesia in patients receiving laparoscopic hysterectomy. Methods Sixty patients who would receive laparoscopic hysterectomy under general anesthesia,with patient's age range being 43~60yr,body weight:45~77 kg, ASAⅠ~Ⅱ,were randomly divided into two groups. The 30 patients in dexmedetomidine group were given loading dose dexmedetomidine 0. 5μg/kg by pump infusion on 10min before anesthesia induction, then pumping continously maintenance dose dexmedetomidine 0. 2μg · kg-1 · h-1 until 40min before the end of operation, however,the 30 patients in control group were given same volume 0. 9% sodium chloride solution. The hemodynamic indexes including HR,SBP,MAP before anesthesia (T0), in extubation (T1), 10min after extubation (T2),were detected, moreover,the related indexes of analepsia quality including bucking, restlessness, shivering, residence time in postoperative recovery room were observed and compared between two groups. Results The intraoperative application of dexmedetomidine could obviously improve the analepsia quality in patients receiving laparoscopic hysterectomy. There were significant diffrences in the hemodynamic indexes including HR,SBP,MAP in T0,T1,T2 and the incidence rates of bucking, restlessness, shivering between dexmedetomidine group and control group ( P <0. 05), however, there was no significant difference in the residence time in postoperative recovery room between the two groups ( P >0. 05). Conclusion The application of dexmedetomidine in patients receiving laparoscopic hysterectomy has the advantages of fewer cardiovascular responses during extubation, more stable hemodynamic indexes, lower incidence rate of bucking, which can decrease effectively the incidence rates of postoperative restlessness and shiver, thus,which is a feasible scheme in clinical practice.