不同剂量右美托咪定对开腹全子宫切除术患者苏醒质量、血流动力学和应激反应的影响  

Effects of Different Doses of Dexmedetomidine on Quality of Recovery,Hemodynamics and Stress Response in Patients with Open Total Hysterectomy

作　　者：贾小梅 高彦军 JIA Xiaomei;GAO Yanjun(Department of Anesthesiology,Shenmu Hospital,Northwest University,Yulin,Shanxi 719313,China)

机构地区：[1]西北大学附属神木医院麻醉科,陕西榆林719313

出　　处：《临床误诊误治》2024年第20期81-86,共6页Clinical Misdiagnosis & Mistherapy

基　　金：国家卫生健康委“十四五”规划全国重点课题(YYWS5661);陕西省2021年科技计划项目(2021SF-055)。

摘　　要：目的 分析不同剂量右美托咪定对开腹全子宫切除术患者的苏醒质量、血流动力学和应激反应的影响,以提高疗效及手术安全性。方法 将2022年1月至2024年1月接受开腹全子宫切除术治疗患者93例采用随机数字表法分为A、B、C组各31例。麻醉诱导前10 min A、B组予右美托咪定0.50μg/kg静脉泵注,C组静脉泵注0.5 mg/kg 0.9%氯化钠注射液,手术结束前15 min A、B、C组分别微量泵泵注右美托咪定0.50、1.00μg/kg和0.5 mg/kg 0.9%氯化钠注射液。比较各组苏醒质量,术后1、6、12 h Ramsay镇静评分和疼痛视觉模拟评分法(VAS)评分,麻醉诱导前(T1)、拔管前1 min(T2)、拔管时(T3)、拔管后3 min(T4)各组血流动力学指标,T1、T3、T4时各组应激反应指标,以及随访1 d各组不良反应。结果 苏醒及拔管时间A、C组较B组短(P<0.05)。术后1、6、12 h 3组Ramsay镇静评分呈逐渐降低趋势(P<0.05),术后6、12 h Ramsay镇静评分A、C组较B组高(P<0.05);3组术后1、6、12 h VAS评分呈先升后降趋势(P<0.05),与术后1 h比较术后12 h 3组VAS评分升高(P<0.05),且术后6、12 h VAS评分A、C组较B组低(P<0.05)。与T1、T2时比较T3时C组舒张压、收缩压均升高(P<0.05),与T3时比较T4时C组舒张压、收缩压均降低(P<0.05);T2、T3、T4时A、B组舒张压、收缩压均低于C组(P<0.05);与T1、T2时比较T3、T4时C组心率均升高(P<0.05),T3、T4时A、B组心率均低于C组(P<0.05)。与T1时比较,T3、T4时A、B、C组血浆肾上腺素、促肾上腺皮质激素(ACTH)、皮质醇、去甲肾上腺素(NA)水平均逐渐升高(P<0.05);T3、T4时B组血浆肾上腺素、ACTH、皮质醇、NA水平均低于A、C组,A组均低于C组(P<0.05)。随访1 d,高血压、心动过速发生率A、B组较C组低,低血压、心动过缓发生率A、C组较B组低(P<0.05,P<0.01)。结论 相较于1.00μg/kg的右美托咪定,0.50μg/kg的右美托咪定能提高开腹全子宫切除术患者的苏醒质量,镇静、镇痛作用好,更利Objective To analyze the effects of different doses of Dexmedetomidine on the quality of recovery,hemodynamics and stress response in patients with open total hysterectomy.Methods A total of 93 patients who received open total hysterectomy from January 2022 to January 2024 were divided into groups A,B and C by random number table method,with 31 patients in each group.Groups A and B received intravenous infusion of 0.50μg/kg Dexmedetomidine at 10 min before anesthesia induction,group C was received intravenous infusion of 0.5 mg/kg 0.9%Sodium Chloride.At 15 min before the end of surgery,groups A,B and C were injected with 0.50,1.00μg/kg Dexmedetomidine and 0.5 mg/kg 0.9%Sodium Chloride injection,respectively.The quality of recovery,Ramsay sedation score(RSS)and visual analogue scale(VAS)score at 1,6 and 12 h after surgery,hemodynamic indexes of all groups before induction of anesthesia(T1),at 1 min before extubation(T2),during extubation(T3)and at 3 min after extubation(T4),and stress response indexes of all groups at T1,T3 and T4 were compared.The adverse reactions in each group were followed up within 1 day.Results The time of recovery and extubation in groups A and C was shorter than that in group B(P<0.05).The RSS at 1,6 and 12 h after surgery was gradually decreased(P<0.05),and the RSS at 6 and 12 h after surgery in groups A and C was higher than that in group B(P<0.05).The VAS score of the three groups at 1,6 and 12 h after surgery showed a trend of first increase and then decrease(P<0.05),and the VAS score of the three groups at 12 h after surgery was higher than that at 1 h after surgery(P<0.05),and the VAS score of the three groups at 6 and 12 h after surgery was lower than that of group B(P<0.05).Compared with T1 and T2,the diastolic blood pressure(DBP)and systolic blood pressure(SBP)of group C at T3 were increased(P<0.05),and the DBP and SBP of group C at T4 were decreased compared with those at T3(P<0.05).DBP and SBP in groups A and B were lower than those in group C at T2,T3 and T4(P<0.05).Compared

关 键 词：右美托咪定 开腹全子宫切除术 麻醉 苏醒质量 血流动力学 应激反应 药物毒性 

分 类 号：R614[医药卫生—麻醉学]