经皮电刺激超前镇痛与麻醉诱导前静脉泵注利多卡因复合右美托咪定在腹腔镜子宫切除手术中的应用比较  

Comparison of the application of percutaneous electrical stimulation for preemptive analgesia and intravenous infusion of lidocaine combined with dexmedetomidine before anesthesia induction in laparoscopic hysterectomy

作　　者：惠羽佳 陈丽萍 贾谜谜 张瑾 徐萌 HUI Yu-jia;CHEN LI-ping;JIA Mi-mi;ZHANG Jin;XU Meng(Department of Anesthesia Operating Room,Northwest Women and Children′s Hospital,Shaanxi Province,Xi′an 710061,China)

机构地区：[1]西北妇女儿童医院麻醉手术室,陕西西安710061

出　　处：《河北医科大学学报》2024年第11期1283-1288,共6页Journal of Hebei Medical University

基　　金：陕西省科学技术研究发展计划项目(2019K12-01)。

摘　　要：目的探讨经皮电刺激超前镇痛与麻醉诱导前静脉泵注利多卡因复合右美托咪定在腹腔镜子宫切除手术中的效果比较。方法选取在西北妇女儿童医院行腹腔镜子宫切除术患者140例,采用随机数字表法将患者分为A组(n=70)和B组(n=70),2组均在全身麻醉下手术,A组给予经皮电刺激超前镇痛,B组给予麻醉诱导前静脉泵注利多卡因复合右美托咪定,观察2组手术时间、术中失血量、不良反应等,同时观察2组不同时间点心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、血氧饱和度(oxygen saturation,SpO_(2))、脑电双频谱指数(bispectral index,BIS)应激炎症因子、疼痛视觉模拟评分(pain visual analogue score,VAS)等差异。结果A组苏醒时间和拔管时间,明显快于B组(P<0.05);A组和B组的HR、MAP、BIS值较均是先降低再升高,在时点间差异有统计学意义(P<0.05),在组间、组间·时点间交互作用差异无统计学意义(P>0.05);2组术后皮质醇(cortisol,Cor)、去甲肾上腺素(norepinephrine,NE)、白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)和C反应蛋白(C-reactive protein,CRP)比较差异无统计学意义(P>0.05);2组术后2 h、6 h、12 h和24 h疼痛VAS比较差异无统计学意义(P>0.05);A组恶性呕吐、术后认知功能障碍和心动过缓发生率明显低于B组(P<0.05)。结论经皮电刺激超前镇痛与麻醉诱导前静脉泵注利多卡因复合右美托咪定在腹腔镜子宫切除手术中有较好的应用价值,其中经皮电刺激超前镇痛术后恢复更快,不良反应发生率低。Objective To explore the comparison of the effects of percutaneous electrical stimulation for preemptive analgesia and intravenous infusion of lidocaine combined with dexmedetomidine before anesthesia induction in laparoscopic hysterectomy.Methods A total of 140 patients who underwent laparoscopic hysterectomy in Northwest Women and Children′s Hospital were selected,and the patients were divided into Group A(n=70)and Group B(n=70)by a random number table method.Both groups underwent laparoscopic hysterectomy,Group A received percutaneous electrical stimulation for preemptive analgesia,while Group B received intravenous infusion of lidocaine combined with dexmedetomidine before anesthesia induction.The differences including duration of operation,intraoperative blood loss,and adverse reactions between the two groups were observed.In the meantime,the differences in heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SpO_(2)),bispectral index(BIS),stress inflammatory factors,and visual analogue scale(VAS)pain score between the two groups at different time points were observed.Results The awakening time and extubation time of Group A were significantly faster than those of Group B(P<0.04).HR,MAP,and BIS values of Group A and Group B showed a decrease followed by an increase,with significant differences in time points(P<0.05).However,there was no significant difference in the interaction between groups or time points between groups(P>0.05).There was no significant difference in postoperative cortisol(Cor),norepinephrine(NE),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and C-reactive protein(CRP)between the two groups(P>0.05).There was no significant difference in VAS pain scores between the two groups at 2,6,12,and 24 h after surgery(P>0.05).The incidence rates of malignant vomiting,postoperative cognitive impairment,and bradycardia in Group A were significantly lower than those in Group B(P<0.05).Conclusion Percutaneous electrical stimulation for preemptive analgesia and intravenous infusion of lido

关 键 词：腹腔镜检查 子宫切除术 镇痛 

分 类 号：R713.42[医药卫生—妇产科学]