右美托咪定复合七氟烷全麻对妇科腹腔镜手术术后恢复的影响

目的比较右美托咪定（dexmedetomidine,DEX）和瑞芬太尼（remifentanil,REM）复合七氟烷（sevoflurane,SEV）全身麻醉对妇科腹腔镜手术患者术后恢复质量的影响。方法 2010年7月～9月,选择60例20～55岁行妇科腹腔镜手术患者（ASAⅠ～Ⅱ级）按随机数字表归为SEV复合DEX组和SEV复合REM组,每组30例。术前给予DEX或REM诱导量后,术中以维持量静脉泵注复合SEV吸入麻醉,停止气腹时关闭SEV,缝皮时停REM和DEX,观察患者吸气、睁眼、拔管、定向力恢复和肛门排气等恢复时间,及术后不同时点生命体征、疼痛强度数字评分（numeric rating scale,NRS）、Ramsay镇静分级和不良反应,评估患者、恢复室护士和妇科医生对恢复质量的满意度。结果与REM组比较,DEX组拔气管导管时间和肛门排气时间较短[拔气管导管时间（12.0±3.9）min vs.（15.9±5.6）min,t=-3.130,P=0.003;肛门排气时间（18.5±3.4）h vs.（23.6±5.8）h,t=-5.455,P=0.000],睁眼时间和定向力恢复时间较长[睁眼时间（15.5±4.2）min vs.（11.7±2.9）min,t=4.078,P=0.000;定向力恢复时间（19.5±4.9）min vs.（14.8±3.6）min,t=4.315,P=0.000]。术后2 h内,DEX组Ramsay镇静分级较高（P〈0.01）,而NRS评分较低（P〈0.01）,需要追加镇痛药的患者较少（P〈0.05）。DEX组术后寒战（3.3%vs.33.3%,χ2=9.017,P=0.003）和恶心呕吐（6.7%vs.30.0%,χ2=5.455,P=0.020）的发生率较低。患者及恢复室护士对DEX复合麻醉后恢复的满意度较高,但妇科医生对REM组更满意（P〈0.01）。结论与SEV复合REM全麻比较,复合DEX可加快中青年女性妇科腹腔镜手术后呼吸和肛门排气的恢复,减轻疼痛,减少恶心呕吐、寒战发生,提高恢复质量。

Effect of General Anesthetia with Sevoflurane and Dexmedetomidine on Postoperative Recovery for Patients Undergoing Gynecological Laparoscopy

Objective To compare the effects of sevoflurane（SEV） combined with dexmedetomidine（DEX） versus remifentainil（REM） for general anethesia on recovery quality in patients undergone gynecological laparoscopy. Methods Sixty female patients aged 20 to 55（ASAⅠ-Ⅱ）,who were scheduled for gynecological laparoscopy from July 2010 to September 2010,were randomly assigned to DEX and REM groups,with 30 cases in each.Loading doses of DEX and REM were infused before induction.SEV was inhalated to maintain the introperative Narcotrend score D0-E1 and discontinued at the end of pneumoperitoneum.DEX and REM were stopped at wound closure.Times to inspiration,eye opening,extubation and orientation as well as lenth of post-anaesthesia care unit（PACU） stay were recorded.Follow-up evaluations were performed to assess hemodynamic variables,numeric rating scale（NRS） of pain,Ramsay scores,the need for ＂rescue＂ analgesics,side effects as well as resumption of dietary intake and recovery of bowel function.Satisfaction scores（0-100） of the quality of recovery were also evaluated by patient,PACU nurse and surgon. Results The extubation time and bowel function recovery time were significantly shorter in DEX group than those of the REM group [（12.0±3.9） vs.（15.9±5.6） min,t=-3.130,P=0.003;（18.5±3.4） vs.（23.6±5.8） h,t=-5.455,P=0.000,respectively].However,DEX failed to facilitate a significantly faster eye opening and orientation from anesthesia.During the first 2 h after operation,NRS in DEX group was significant lower than those of REM group（P0.01）.Two patients in DEX group requiried recuse opiods,less than that in REM group.The percentages of patients suffering shivering or PONV（postoperative nausea and vomiting） were lower in the DEX group than that in the REM group（3.3% vs.33.3%,χ2=9.017,P=0.003;6.7% vs.30.0%,χ2=5.455,P=0.020,respectively）.Satisfaction scores by in DEX group were higher by both patients and PACU nurses（P0.05;P0.05）,while gynecologists were more satisfied with REM anesthesia（P0.01）. ConclusionsYoung and middle aged female patients anesthetized with DEX-SEV have a faster recovery for respiration and bowel function,lower NRS and incidence rates of shivering,nausea and vomitting.DEX-SEV combined general anethesia may lead to a more satisfied recovery for patients undergone gynecological laparoscopy.