右美托咪定与丙泊酚联合地佐辛用于宫腔镜手术麻醉效应比较  

Comparison of dexmedetomidine or propofol combined with dezocine as assisted sedation in patients undergoing hysteroscopic surgery

作　　者：武英蕾[1] 李宝永[1] 许景伟[1] 张树波[1] 

机构地区：[1]河北联合大学附属医院麻醉科,河北唐山063000

出　　处：《实用临床医药杂志》2013年第7期94-95,97,共3页Journal of Clinical Medicine in Practice

摘　　要：目的观察右美托眯定、丙泊酚分别与地佐辛联合静脉麻醉用于官腔镜手术的临床效果及安全性。方法选择官腔镜手术适应证患者70例，随机分为右美托咪定组（D组）和丙泊酚（P组），每组35例。D组给予右美托咪啶负荷量0．8μg／kg泵注10min后以0．2～0．6μg／（kg·h）维持，P组给予1％异丙酚1．5mg／kg静脉注射后以4～6mg/（kg．h）维持，镇静目标维持Ramsay镇静评分3～4分。术中持续监测心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、呼吸频率（RR）、呼气末二氧化碳分压（PETCO2）、脑电双频指数（Bis）、宫缩痛程度和镇静评分。结果麻醉诱导后2min（T1）、扩宫颈时（T2）、膨胀官腔后1min（T3）P组MAP、SpO2低于D组，RR慢于D组（P〈0．05）；手术结束时（T4）时P组MAP高于D组（P〈0．05）。P组睁眼时间和正确执行指令时间明显长于D组（P〈0．05），呼吸抑制发生率高于D组（P〈0．05）。P组术后宫缩痛重于D组（P〈0．05）。结论右美托咪定复合地佐辛静脉麻醉镇痛效果好，宫缩痛少而轻，苏醒及定向力恢复快，无呼吸抑制，且血流动力学更平稳。Objective To evaluate the effects of sedation, respiration and circulation and ad- verse reactions undergoing hysteroscopic surgery in patients under intravenous anesthesia when dexmedetomidine or propofol combined with dezocine was used as assisted sedation. Methods Sev- enty patients undergoing hysteroscopic surgery under intravenous anesthesia were randomly divided into two groups （ n = 35） ： group D received dexrnedetomidine loading 0.8μg/kg for 10 rain, main- tenance 0.2 - 0.6 μg/（kg· h） ; group P received propofol 1.5 mg/kg then maintained 4 - 6 mg/（kg · h）. All patients received dezocine 5 mg （concentration 1 mg/mL） by intravenous in the preopera- tive 15min. Ramsay sedation score was maintained between 3 to 4 in both groups. HR, MAP, SpO2, RR, PETCO2, BIS, Ramsay sedation score and adverse reactions were recorded. Results The ramsay sedation score all reached 3 to 4 at the beginning of operation, and BIS in D group was lower during the operation than in group P. Compared with group D, RR decreased significantly in P group, and PET CO2 increased significantly. Patients in group P that had to be inserted with orophatyngeal airway or given assisted ventilation （SpO2≤90%） were significantly more than pa- tients in group D. Compared with group P, HR decreased significantly in group D, MAP decreased slightly, but MAP decreased significantly in group P during the operation. Patients with dysphoria and loquacity in group P was much more than that in group D. Conclusion Compared with propo- fol combined with dezocine, the use of dexmedetomidine combined with dezocine in patients under- going hysteroscopic surgery under intravenous anesthesia causes little and mild uterine contraction pain. In addition, it can provide perfect effects of sedation with a light effect on breath and blood circulation and adverse reaction.

关 键 词：右美托咪定 丙泊酚 地佐辛 静脉麻醉 宫腔镜手术 疼痛 

分 类 号：R614[医药卫生—麻醉学]