右美托咪定在妇科腹腔镜全身麻醉手术苏醒期应用的效果及安全性

目的 观察术中输注右美托咪定在妇科腹腔镜全身麻醉手术后苏醒期应用的效果及安全性.方法 将80例择期行妇科腹腔镜手术患者完全随机分成右美托咪定组和对照组,每组40例.停用麻醉药后,右美托咪定组经静脉泵注右美托咪定0.4 μg/kg,10 min泵完;对照组输注等量0.9%氯化钠注射液.观察麻醉诱导前、气管插管拔管时和气管插管拔管后不同时间点平均动脉压（MAP）和心率的变化﹔患者苏醒时间、拔管时间以及拔管后10 min 视觉模拟评分（VAS）、警觉与镇静评分（OAA/S）、躁动发生率.结果与对照组比较,右美托咪定组拔管时及拔管后5 min、拔管后10 min的MAP明显降低,心率明显减慢MAP：（89±14）mmHg（1 mmHg=0.133 kPa）比（107±15）mmHg,（75±13）mmHg比（98±16）mmHg,（78±17）mmHg比（95±15）mmHg;心率：（82±11）次/min比（113±13）次/min,（64±12）次/min比（97±11）次/min,（66±13）次/min比（108±13）次/min]（均P〈0.05）;右美托咪定组拔管后10 min VAS评分和OAA/S评分明显低于对照组（2.6±0.6）分比（7.9±0.9）分,（3.9±0.5）分比（4.6±0.3）分] （P〈0.05）;右美托咪定组躁动发生率明显低于对照组17.5%（7/14）比65.0%（26/40）,P＜0.05].结论 术中输注右美托咪定能预防妇科腹腔镜全身麻醉手术后苏醒期心血管反应,降低术后苏醒期躁动的发生率.

Effects and safety of dexmedetomidine on quality of resuscitation in patients undergoing general anesthesia after gynaecological laparoscopic surgery

Objective To observe the effect and safety of dexmedetomidine on quality of resuscitation in patients undergoing general anesthesia after gynaecological laparoscopic surgery. Methods Eighty patients with elective gynaecological laparoscopic surgery were randomly divided into two groups：dexmedetomidine group and control group. Patients in dexmedetomidine group was given dexmedetomidine（0.4 μg/kg）intravenously,while control group was given equal volume of saline. Before tracheal extubation at different time points after tracheal extubation mean arterial pressure （MAP） and heart rate （HR）, recovery time, extubation time, and 10 min after extubation visual analog scale （VAS ）, alertness and sedation score （OAA / S）, restlessness and agitation extent and incidence of adverse drug reactions were observed. Results MAP and HR were significantly decreased in dexmedetomidine group than in control group at the moment of extubation and 5,10 min after extubationMAP： （89±14） mmHg vs （107±15） mmHg, （75±13） mmHg vs （98±16） mmHg, （78±17） mmHg vs （95±15） mmHg; HR： （82±11） beats/min vs （113±13） times/min, （64±12） beats/min vs （97±11） times/min, （66±13） beats/min vs （108±13） times / min] （all P〈0.05 ） . The score of VAS and OAA/S were lower at 10 min after extubation in dexmedetomidine group than in control group （2.6±0.6） scores vs （7.9±0.9） scores, （3.9±0.5） scores vs （4.6±0.3） scores] （P〈0.05）.Compared with control group ,the agitation incidence and level were lower in dexmedetomidine group 0 vs 12.5% （5/40）] （P〈0.05）. Conclusion The injection of dexmedetomidine（0.4 μg/kg）with minipump may effectively attenuate the cardiovascular reoponses on quality of resuscitation in patients undergoing general anesthesia after gynaecological laparoscopic surgery,and can reduce the postoperative incidence of agitation.