右美托咪定联合丙泊酚在硬膜外麻醉妇科手术患者中的应用  

Application of dexmedetomidine combined with propofol in gynecological surgery under epidural anesthesia

作　　者：张耀贤[1] 刘占立[1] 吴文燕[1] 刘喜成[1] 郑子豪 ZHANG Yao-xian, LIU Zhan-li, WU Wen-yan, LIU Xi-cheng, ZHENG Zi-hao.(Department of Anesthesiology, the Second Clinical Medical College of Jinan University （Department of Anesthesiology, Shenzhen People＇s Hospital）, Shenzhen 518000, Guangdong, CHINA)

机构地区：[1]暨南大学第二临床医学院麻醉科深圳市人民医院麻醉科,广东深圳518000

出　　处：《海南医学》2018年第7期946-948,共3页Hainan Medical Journal

摘　　要：目的探讨右美托咪定联合丙泊酚硬膜外麻醉在妇科手术患者中的应用效果。方法选取暨南大学第二临床医学院2012年1月至2016年3月在硬膜外麻醉下接受妇科手术的患者80例,以随机数表法将其分为观察组和对照组,每组40例,对照组给予丙泊酚镇静,观察组给予右美托咪定联合丙泊酚镇静,比较两组患者在给药前(T0)、手术开始5 min时(T1)、手术开始20 min时(T2)、手术结束时(T3)的镇静效果,用Ramsay镇静评分进行镇静效果评定,比较两组患者在T0、T1、T2、T3时间段血流动力学指标心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp O2)变化。观察两组患者用药后不良反应。结果观察组患者在T1、T2、T3时间段Ramsay镇静评分分别为(3.16±0.32)分、(4.17±0.23)分、(4.13±0.22)分,均明显高于对照组的(2.12±0.33)分、(2.56±0.22)分、(3.01±0.21)分,差异均具有统计学意义(P<0.05);观察组和对照组患者的HR在T1时间段[(67.9±7.1)次/min、(61.7±7.0)次/min]、T2时间段[(67.3±6.1)次/min、(58.3±6.2)次/min]均明显低于T0时间段[(72.3±7.2)次/min、(72.4±7.1)次/min],且对照组明显低于观察组,差异均具有统计学意义(P<0.05);观察组、对照组患者MAP在T1时间段[(87.7±1.0)mm Hg、(81.7±1.0)mm Hg]、T2时间段[(85.6±2.2)mm Hg、(82.3±2.1)mm Hg]、T3时间段[(88.5±2.7)mm Hg、(83.6±2.8)mm Hg]均明显低于T0时间段[(94.4±1.2)mm Hg、(93.7±1.1)mm Hg],且对照组明显低于观察组,差异均具有统计学意义(P<0.05);观察组患者的不良反应发生率为5.0%,明显低于对照组的32.5%,差异具统计学意义(P<0.05);两组患者不同观察时间段的Sp O2比较差异均无统计学意义(P>0.05)。结论右美托咪定联合丙泊酚在硬膜外麻醉下妇科手术患者中具有良好的镇静效果,其对患者的血液动力学影响小,不良反应发生率低,值得临床推广应用。Objective To discuss the effect of dexmedetomidine combined with propofol on sedation in gynecological surgery under epidural anesthesia.Methods From January 2012 to March 2016,80 patients undergoing gynecological surgery under epidural anesthesia from Department of Anesthesiology,the Second Clinical Medical College of Jinan University were randomly divided into the observation group（n=40） and the control group（n=40）,to receive dexmedetomidine combined with propofol and propofol for sedation.Sedation effect（evaluated by Ramsay sedation score） at before administration（T0）,5 min after operation（T1）,20 min after operation（T2）,at the end of operation（T3） were assessed and compared between the two groups.Hemodynamic indexes such as heart rate（HR）,mean arterial pressure（MAP）,oxygen saturation（SpO_2） changes at T0,T1,T2,T3 were also compared.The adverse reactions were observed in the two groups.Results The Ramsay sedation scores at T1,T2,T3 were（3.16±0.32）,（4.17±0.23）,（4.13±0.22） in the observation group,significantly higher than（2.12±0.33）,（2.56±0.22）,（3.01±0.21） in the control group（P〈0.05）.The HR of the observation group,control group were（69.9 ± 7.1） beats/min,（61.7 ± 7.0） beats/min at T1 and（67.3 ± 6.1） beats/min,（58.3±6.2） beats/min at T2,significantly lower than（72.3±7.2） beats/min,（72.4±7.1） beats/min at T0（P〈0.05）,and the HR in the control group were significantly lower than those in the observation group（P〈0.05）.The MAP of the observation group,control group were（87.7±1.0） mm Hg,（81.7±1.0） mm Hg at T1,（85.6±2.2） mm Hg,（82.3±2.1） mm Hg at T2,（88.5±2.7） mm Hg,（83.6±2.8） mm Hg at T3,which were significantly lower than（94.4±1.2） mm Hg,（93.7±1.1） mm Hg at T0（P〈0.05）,and the levels in the control group were significantly lower than those in the observation group（P〈0.05）.Adverse reaction rate was 5.0% in the observation group,significantly lower than

关 键 词：硬膜外麻醉 右美托咪定 丙泊酚 镇静 

分 类 号：R713[医药卫生—妇产科学]