右美托咪定或丙泊酚复合舒芬太尼对宫腔镜手术患者镇痛镇静及应激反应的影响  

Effects of Dexmedetomidine or Propofol Combined with Sufentanil on Analgesia,Sedation and Stress Response in Patients Undergoing Hysteroscopic Surgery

作　　者：贾小梅 高彦军 赵建华 JIA Xiaomei;GAO Yanjun;ZHAO Jianhua(Department of Anesthesiology,Shenmu Hospital Affiliated to Northwest University,Yulin,Shaanxi 719399,China;Department of Anesthesiology,Qinhuangdao Hospital,Peking University Third Hospital,Qinhuangdao,Hebei 066000,China)

机构地区：[1]西北大学附属神木医院麻醉科,陕西榆林719399 [2]北京大学第三医院秦皇岛医院麻醉科,河北秦皇岛066000

出　　处：《临床误诊误治》2025年第4期55-59,共5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)。

摘　　要：目的探讨右美托咪定或丙泊酚复合舒芬太尼对宫腔镜手术患者镇痛镇静及应激反应的影响。方法选取2021年6月至2023年6月接受宫腔镜手术治疗的患者358例,随机数字表法分为A、B组,每组179例。A组给予丙泊酚复合舒芬太尼,B组给予右美托咪定复合舒芬太尼。比较2组手术相关指标、镇静镇痛情况、舒适程度、麻醉深度监测指标、血流动力学指标、应激反应及不良反应发生情况。结果与A组比较,B组麻醉诱导时间更短,苏醒时间更长,患者苏醒后Ramsay镇静评分及观察期间体动发生率更高,视觉模拟评分法评分及观察期间注射痛、呼吸抑制发生率更低(P<0.05)。刮宫时、术毕时、患者意识恢复时,与A组比较,B组小波指数和镇痛指数更高,心率、收缩压、舒张压更低(P<0.05)。术后12、24 h,与A组比较,B组血清促肾上腺皮质激素、皮质醇、丙二醛水平更低,舒适评分及血清总抗氧化状态水平更高(P<0.05)。结论右美托咪定复合舒芬太尼在宫腔镜手术中具有良好应用效果,但可能延长患者苏醒时间,术中需密切关注心率及体动情况。Objective To investigate the effects of Dexmedetomidine or Propofol combined with Sufentanil on analgesia,sedation and stress response in patients undergoing hysteroscopic surgery.Methods A total of 358 patients who received hysteroscopic surgery from June 2021 to June 2023 were selected and divided into groups A and B by random number table method,with 179 patients in each group.Group A was given Propofol combined with Sufentanil,and group B was given Dexmedetomidine combined with Sufentanil.The surgery-related indexes,sedation and analgesia,comfort level,monitoring indexes of anesthesia depth,hemodynamic indexes,stress response and occurrence of adverse reactions were compared between the two groups.Results Compared with group A,group B had shorter anesthesia induction time,longer recovery time,higher Ramsay sedation score after recovery,higher incidence of body movement during observation,lower visual simulation score,and lower incidence of injection pain and respiratory depression during observation(P<0.05).Compared with group A,group B had higher wavelet index and analgesia index,and lower heart rate,systolic blood pressure and diastolic blood pressure during curettage,after surgery and after consciousness recovery(P<0.05).At 12 and 24 h after surgery,compared with group A,the levels of serum adrenocorticotropin,cortisol and malondialdehyde in group B were lower,while the levels of comfort score and serum total antioxidant status in group B were higher(P<0.05).Conclusion Dexmedetomidine combined with Sufentanil has a good application effect in hysteroscopic surgery,but it may prolong the recovery time of patients.Therefore,it is necessary to pay close attention to the heart rate and body movement during the surgery.

关 键 词：宫腔镜手术 右美托咪定 丙泊酚 舒芬太尼 镇痛 镇静 皮质醇 丙二醛 

分 类 号：R614[医药卫生—麻醉学]