右美托咪定复合瑞芬太尼在妇科日间手术麻醉中的应用

[目的]观察右美托咪定复合瑞芬太尼在妇科日间手术麻醉中的应用价值.[方法]选择妇科日间手术患者100例,按照随机数表法分为右美托咪定复合瑞芬太尼组(观察组)和丙泊酚组(对照组),两组均采用血浆浓度靶控输注全凭静脉麻醉(TCI),观察组采用双通道靶控输注右美托咪定(血浆靶浓度0.3 ng/mL)和瑞芬太尼(血浆靶浓度1.5 ng/mL),对照组靶控输注丙泊酚(血浆靶浓度3.0μg/mL),术中发生体动时观察组加注瑞芬太尼,对照组加注丙泊酚,至体动消失.记录患者麻醉诱导前(T1)、手术开始前(T2)、术中(T3)、苏醒时(T4)的平均动脉压(MAP)、血氧饱和度(SpO2)、心率(HR);记录患者术中发生体动的情况;记录患者呼吸抑制(SpO2<90%或呼吸暂停>15 s)和术后苏醒时间(手术结束至可唤醒睁眼、按指令握手的时间)及术后宫缩痛的发生情况(VAS评分);记录两组抽药至麻醉诱导的时间.[结果]T1、T3时两组MAP、SpO2、HR比较差异无统计学意义(P>0.05);T2时观察组MAP、SpO2、HR明显高于对照组(P<0.05);T4时对照组MAP、HR显著高于观察组(P<0.05),而两组SpO2差异无统计学意义(P>0.05).观察组术中体动例数明显少于对照组(P<0.05),术后苏醒时间明显短于对照组(P<0.05),但两组呼吸抑制发生率比较差异无统计学意义(P>0.05).观察组术后宫缩痛显著好于对照组(P<0.05);麻醉诱导时间长于对照组(P<0.05).[结论]在妇科日间手术中,右美托咪定复合瑞芬太尼麻醉效果确切,且能明显减轻术后宫缩痛,缩短患者术后苏醒时间和质量,提高患者和手术操作的舒适度,但与丙泊酚比较价格昂贵且操作时间延长,对于有丙泊酚禁忌证的妇科日间手术患者,复合应用右美托咪定和瑞芬太尼麻醉是一种合适的选择.

Application of Dexmedetomidine Combined with Remifentanil in Anesthesia of Gynecological Daytime Operation

[Objective]To observe the anesthesia effect of dexmedetomidine combined with remifentanil in gynecological daytime operation[.Methods]One hundred cases of gynecological day surgery were selected,and were divided into dexmedetomidine combined with remifentanil group(observation group)and propofol group(control group)according to the random number table method.Both groups were treated with plasma concentration target controlled infusion of intravenous anesthesia(TCI),the observation group with dual‐channel target controlled infusion of dexmedetomidine(plasma target concentration 03.ng/mL)and remifentanil(plasma target concentration 15.ng/mL),and the control group with target controlled infusion of propofol(plasma target concentration 30.μg/mL).When the patient showed body movement during operation,the observation group was injected with remifentanil and the control group with propofol until body movement disappeared T.he mean arterial pressure(map),blood oxygen saturation(SpO2),heart rate(HR)of patients before anesthesia induction(T1),before operation(T2),during operation(T3)and during recovery(T4)were recorded;the physical activity of patients during operation was recorded;the respiratory inhibition(SpO2<90%or apnea>15s)was recorded;and the recovery time(from the end of operation to wake up and open eyes,handshake according to instructions)and the occurrence of postoperative uterine contraction pain(VAS score)were recorded,and the time from drug withdrawal to anesthesia induction in the two groups were recorded[Results]There was no significant difference in map,SpO2 and HR between the two groups at T 1 and T3(P>00.5);map,SpO2 and HR in the observation group at T 2 were significantly higher than those in the control group(P<00.5);The MAP and HR in the control group at T 4 were significantly higher than those in the observation group(P<00.5),but there was no significant difference in SpO2 between the two groups(P>00.5).The number of body movement of patients in the observation group was significantly less than that in the control group(P<00.5),and the recovery time was significantly shorter than that in the control group(P<00.5),but there was no significant difference in the incidence of respiratory inhibition between the two groups(P>00.5).The time of anesthesia induction in the observation group was longer than that in the control group(P<00.5).[Conclusion]Inthe gynecological daytime operation,dexmedetomidine combined with remifentanil has a definite anesthesia effect,can obviously reduce the postoperative uterine contraction pain,shorten the recovery time and quality of patients,and improve the comfort of patients and operation.However,it is more expensive and longer than propofol F.or the patients with propofol contraindications in gynecological day‐time surgery,the combination of dextromethoridine and remifentanil anesthesia is an appropriate choice.