右美托咪定与吗啡鞘内注射在开腹子宫肌瘤剔除术中的作用比较  

Effects comparison between intrathecal injection of Dexmedetomidine and Morphine in transabdominal myomectomy

作　　者：齐晓非[1] 李泳[1] 刘丹勇 

机构地区：[1]南方医科大学附属深圳市妇幼保健院麻醉科,广东深圳518028

出　　处：《中国医药导报》2015年第5期59-62,共4页China Medical Herald

基　　金：广东省深圳市卫计委课题(编号201402062)

摘　　要：目的 对比鞘内右美托咪定与鞘内吗啡在妇科开腹子宫肌瘤手术麻醉中的作用。方法 选择南方医科大学附属深圳市妇幼保健院2014年6~10月择期行开腹子宫肌瘤剔除术患者120例,随机分为3组,右美托咪定（BD）组、吗啡（BM）组、对照组（B组）,每组40例。均行腰硬联合麻醉,BD组腰麻药为含右美托咪定5μg的布比卡因10 mg,BM组腰麻药为含吗啡0.1 mg的布比卡因10 mg,B组为0.5%布比卡因10 mg。观察感觉和运动阻滞情况;恶心呕吐、瘙痒、寒战等不良反应情况;术后4、8、12、24 h镇痛情况。结果 鞘内注射右美托咪定（BD组）能延长感觉和运动阻滞时间,与B组相比[感觉阻滞时间：（251.25±40.24）min比（189.44±38.97）min,运动阻滞时间：（226.31±40.72）min比（164.94±26.11）min],差异有高度统计学意义（P〈0.01）。鞘内注射右美托咪定（BD组）与吗啡（BM组）有类似的镇痛作用,镇痛维持时间分别是（17.5±8.3）h和（16.3±7.2）h,差异无统计学意义（P〉0.05）。BD组瘙痒、寒战发生率较BM组明显减少,差异有高度统计学意义（P〈0.01）。结论 右美托咪定可以替代吗啡作为鞘内辅助用药而无明显不良反应。Objective To compare the effects of intrathecal injection of Dexmedetomidine and Morphine in anesthesia of transabdominal myomectomy. Methods 120 patients underwent selective transabdominal myomectomy in Shenzhen Maternity and Child Care Center Affiliated to Southern Medical University from June to October 2014 were selected and divided into 3 groups： Bupivacaine combined with Dexmedetemidine （BD） group, Bupivacaine combined with Mor- phine （BM） group, control （Bupivacaine, B） group, each group had 40 cases. All groups were given combined spinal epidural anesthesia. Group BD given 10 mg Bupivacaine and 5 μg Dexmedetomidine; group BM given 10 mg Bupiva- caine and 0.1 mg Morphine; group B given 10 mg 0.5% Bupivacaine only. Sensory and motion block situation, adverse reactions of nausea and vomiting, pruritus, chills; analgesia situation of 4, 8, 12, 24 h after operation were observed and compared between the two groups. Results Intrathecal injection of Dexmedetomidine （BD group） could prolong sensory and motion block, compared with the B group [sensory block time： （251.25±40.24） min vs （189.44±38.97） min; motor block time： （226.31±40.72） min vs （164.94±26.11） min], the differences were statistically significant （P 〈 0.01）. Dexmedetomidine （BD group） had similar analgesia effect with Morphine （BM group）, the duration of analgesia was （17.5±8.3） h and （16.3±7.2） h respectively, the difference was not statistically significant （P 〉 0.05）. The incidence of pruritus and chills in the BD group was less than that in the BM group, the difference was statistically significant （P 〈 0.01）. Conclusion Dexmedetomidine can replace Morphine as intrathecal adjuvant drug and has little obvious adverse reaction.

关 键 词：右美托咪定 子宫肌瘤剔除术 鞘内 吗啡 

分 类 号：R714[医药卫生—妇产科学]