右美托咪定复合丙泊酚、瑞芬太尼靶控全身麻醉在腹腔镜全子宫切除术中的应用

摘要

目的：观察右美托咪定复合丙泊酚瑞芬太尼靶控全身麻醉在腹腔镜全子宫切除术中的应用对血流动力学及围术期不良反应的影响。方法将60例行腹腔镜下全子宫切除术的患者（年龄30～60岁，ASA 分级Ⅰ—Ⅱ级，无心血管病史）按麻醉用药的不同分为 D 组和 C 组，每组30例。D 组在麻醉诱导前15 min 泵注盐酸右美托咪定注射液0．5μg·kg－1，并持续泵注盐酸右美托咪定注射液0．2μg·kg－1·h－1至手术结束前40 min 停药；C 组泵注等容量的0．9％氯化钠注射液。观察2组用药前（T0），给药15 min 后（T1），插管时（T2）、气腹完成时（T3），拔管时（T4）和拔管后30 min（T5）的血流动力学指标[心率（HR）、收缩压（SBP）、舒张压（DBP）]，手术时间、脑电双频指数（BIS）值，丙泊酚注射液、枸橼酸芬太尼注射液、盐酸右美托咪定注射液的使用量，围术期不良反应[HR 减慢＜50次·min－1，拔管呛咳、术后恶心呕吐、寒颤，苏醒延迟（＞30 min）]发生率。术后30 min 对2组进行视觉模拟评分法（VAS 法）评分。结果与 C 组比较，D 组丙泊酚注射液、枸橼酸芬太尼注射液使用量均明显减少，HR 减慢＜50次·min－1发生率则明显升高，T1—T5时点 SBP、DBP、HR 和拔管呛咳、术后恶心呕吐、寒颤发生率及术后30 min VAS 得分均明显降低（均 P ＜0．05）。结论右美托咪定复合丙泊酚、瑞芬太尼联合靶控输注用于妇科腹腔镜下全子宫切除术可减少患者术中的应激反应，维持患者的循环稳定，减少麻醉药物使用量，降低围术期不良反应发生率。%ABSTRACT:Objective To observe the effects of dexmedetomidine combined with propofol and remifentanil target-controlled infusion(TCI)for general anesthesia on hemodynamics and periop-erative adverse reactions in laparoscopic hysterectomy.Methods Sixty patients without history of cardiovascular disease(ASA Ⅰ-Ⅱ,30-60 years old)who received laparoscopic hysterectomy were randomly divided into two groups,with 30 patients in each group.Patients in group D were in-fused with dexmedetomidine injection(0.5 μg·kg-1 )15 minutes before anesthesia induction and then given the maintenance dose of dexmedetomidine injection(0.2 μg·kg-1 ·h-1 )until 40 mi-nutes before the end of operation.Patients in group C were infused with the equal volume of 0.9% sodium chloride injection.Heart rate (HR),systolic blood pressure (SBP)and diastolic blood pressure(DBP)were recorded before administration(T0),15 min after administration(T1), at intubation(T2),at the end of pneumoperitoneum(T3),at extubation(T4),and 30 min after ex-tubation(T5).Furthermore,operation time,bispectral index(BIS),dosages of propofol,fentanyl citrate and dexmedetomidine hydrochloride injection,and incidences of perioperative adverse reac-tions(HR<50 beats·min-1 ,extubation cough,postoperative nausea and vomiting,shivering,and recovery time>30 min)were observed in both groups.In addition,VAS score was compared be-tween the two groups 30 min after operation.Results Compared with group C,dexmedetomidine infusion significantly decreased the usage amount of propofol and fentanyl citrate injection,SBP, DBP and HR at T1-T5,incidences of extubation cough,nausea,vomiting and shivering,and post-operative VAS score,and obviously increased the incidence of HR<50 beats·min-1 (P <0.05). Conclusion Dexmedetomidine combined with propofol and remifentanil TCI for general anesthe-sia can relieve intraoperative stress response,maintain circulation stability,reduce anesthetic us-age,and decrease the incidence of perioperative adverse reactions in laparoscopic hysterectomy.