小剂量右美托咪定单次注药在人流镇痛术中的应用

目的 探讨小剂量右美托咪定单次注药在人流镇痛中的应用。方法 选取门诊要求人流镇痛术患者84例,随机分为右美托咪定组(D组42例)和对照组(C组42例)。D组入室后,20ug右美托咪定入壶,10min后给予芬太尼0.05mg和适量丙泊酚维持麻醉深度。C组入室后给予等量生理盐水,其余方法相同。监测指标:给药前(T₀)、右美托咪定给药10min(T₁)、睫毛反射消失时(T₂)、清理宫腔时(T₃)、手术结束时(T₄)、术后15min(T₅)、术后30min(T₆)的MAP、HR、SPO₂;体动反应和舌后坠发生次数;手术持续时间;停药后苏醒时间;丙泊酚总用量;患者自觉舒适度评分。结果 HR:T₁- T₅时D组低于C组(T₁-T₄时 P＜0.01 ,T₅时P＜0.05);与T₀比较,D组T₁-T₅均低于T₀,术中波动较C组小(P＜0.05)。 MAP: T₃,T₄时D组低于C组(P＜0.05),T₂时D组高于C组(P＜0.05);与T₀比较术中D组HR、MAP波动较C组低(P＜0.05);丙泊酚总用量、体动反应和舌后坠发生次数D组均低于C组(P＜0.01);停药后苏醒时间和患者自觉舒适度评分D组高于C组(P＜0.05)。结论 小剂量右美托咪定单次注药有利于人流镇痛中的血流动力学稳定,对呼吸影响小,能减少麻醉药用量,患者自觉舒适度佳,值得推广。

Using of single low-dose dexmedetomidine in painless artificial abortion

Objective This study was to investigate the using of single low-dose dexmedetomidine in painless artificial abortion.Methods 84 patients scheduled for painless artificial abortion were randomly divided into the dexmedetomidine group(group D n=42) and the control group(group C n=42). Patients in group D were given dexmedetomidine 20 g by vein infusion, after 10 min fentanyl 0.05mg and proper amount propofol to keep the depth of anesthesia. Patients in group C were given the same amount of saline and the same medicine to keep the depth of anesthesia. The MAP、HR and SPO₂ in two groups were recorded before the drug administration(T₀), 10 min after the dexmedetomidine or saline were given(T₁), at the time of eyelash reflex vanished(T₂), during clearing cavity of uterus(T₃), the completion of surgery(T₄),15min after surgery(T₅),30min after surgery(T₆).Physical activity and number of tongue fall,duration of surgery, recovery time after discontinuation,total propofol dose,and patient comfort level were monitored.Results HR:T₁~T₅ were lower in group D than in group C (P＜0.01 for T₁~T₄, P＜0.05 for T₅). Compared with T₀, T₁~T₅ in group D was lower than T₀, and intraoperative fluctuation was smaller than that in group C (P＜0.05). MAP: T₃ and T₄ were lower in group D than in group C (P＜0.05). In group T₂, group D was higher than group C (P＜0.05). Compared with T₀, the fluctuations of HR and MAP in group D were lower than those in group C (P＜ 0.05). The total dose of propofol, body reaction and number of cases of tongue falling were lower in group D than in group C (P＜0.01). The time of resuscitation and patient’s consciousness of comfort were higher in group D than in group C (P＜0.05).Conclusion Single low-dose dexmedetomidine using in painless artificial abortion is beneficial to the stability of hemodynamics in analgesia of human anesthesia, has little effect on respiration, can reduce the dosage of anesthetic, and has good comfort for patients and it is worth promoting.