右旋美托咪啶复合瑞芬太尼静脉麻醉在腹腔镜子宫切除术中的效果观察

目的探讨右旋美托咪啶复合瑞芬太尼静脉麻醉应用于腹腔镜子宫切除术的效果。方法选择2012年8月—2014年1月于河北大学附属医院行腹腔镜子宫切除术的患者54例,随机分为观察组和对照组各27例。对照组予瑞芬太尼0.3μg/kg、丙泊酚2 mg/kg、维库溴铵0.1 mg/kg麻醉诱导;观察组予右旋美托咪啶复合瑞芬太尼静脉麻醉,在麻醉诱导前采用右旋美托咪啶0.8μg/kg,泵注10 min,继以0.6μg/（kg·h）静脉维持,余同对照组。持续监测各项生命体征,记录患者麻醉前5 min（T0）、麻醉诱导后（T1）、气管插管后（T2）、手术开始时（T3）、冲洗腹腔时（T4）和手术结束时（T5）的心率（HR）、平均动脉压（MAP）、心输出量（CO）,并对两组术后的疼痛视觉模拟评分法（VAS）评分、意识恢复时间、定向力恢复时间以及住院时间进行比较。结果观察组在T2、T4、T5时的HR,在T2、T3时的MAP均显著低于对照组（P〈0.05）,两组各时点CO比较差异无统计学意义（P〉0.05）;与T1时比较,对照组各指标波动明显,尤以MAP、CO为著（P〈0.05）,观察组则较为平稳。观察组术后2、8 h疼痛VAS评分、意识恢复时间、定向力恢复时间均显著短于对照组（P〈0.05）,两组术后24 h疼痛VAS评分和住院时间差异则无统计学意义（P〉0.05）。结论右旋美托咪啶复合瑞芬太尼静脉麻醉应用于腹腔镜子宫切除术,麻醉效果平稳,镇静充分,患者恢复也较好,值得临床推广应用。

Effect Observation of Dexmedetomidine Combined with Remifentanil in Application of Laparoscopically Hysterectomy with Intravenous Anesthesia

Objective To investigate the effect of Dexmedetomidine combined with Remifentanil in application of laparoscopically hysterectomy with intravenous anesthesia. Methods A total of 54 patients,who underwent laparoscopically hysterectomy during August 2012 and January 2014,were randomly divided into observation group（ n = 27）and control group（ n = 27）. The control group was given anesthesia induction by using 0. 3 μg / kg Remifentanil,2 mg /kg Propofol and 0. 1 mg / kg Vecuronium Bromide; while the observation group was given intravenous anesthesia by using Dexmedetomidine combined with Remifentanil,and before the anesthesia induction,0. 8 μg / kg Dexmedetomidine was induced by infusion for 10 min,followed by an infusion of 0. 6 μg /（ kg·h） intravenous maintenance,and then the remaining methods were similar to that of control group. The vital signs were monitored continuously,and values of heart rate（ HR）,mean arterial pressure（ MAP） and cardiac output（ CO） were recorded 5 minutes before anesthesia（ T0）,after induction（ T1）,after intubation（ T2）,at the beginning of the operation（ T3）,at the time of washing abdominal cavity（ T4） and at the end of the operation（ T5）. The postoperative pain score of visual analogue scales（ VAS）,consciousness recovery time,orientation recovery time and hospitalization time in the two groups were compared. Results In the observation group,values of HR at T2,T4 and T5and MAP at T2 and T3were significantly lower than those in the control group（ P〈0. 05）,but there were no significant differences in CO values at all time points between the two groups（ P 〉0. 05）; compared with the indexes at T1,the indexes at the other time points were obviously undulate in control group expecially for MAP and CO,while the indexes were more stable in observation group. VAS pain scores,consciousness recovery time and orientation recovery time in observation group on 2 h and 8 h after the operation were significantly less than those in control g