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 0.50 μg/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、1.00 μg/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1d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、12h3 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1h比较术后12h3 组VAS评分升高(P＜0.05),且术后6、12h 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1d,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1.00 μg/kg的右美托咪定,0.50 μg/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,更利于减轻术中应激反应,维持血流动力学稳定状态,且安全性高.
Abstract
Objective To analyze the effects of different doses of Dexmedetomidine on the quality of recovery,hemo-dynamics and stress response in patients with open total hysterectomy.Methods A total of 93 patients who received open to-tal 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 0.50 μg/kg Dexmedetomidine at 10 min be-fore 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 with0.50,1.00 μg/kg Dexmedetomidine and0.5 mg/kg0.9%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 re-covery and extubation in groups A and C was shorter than that in group B(P＜0.05).The RSS at 1,6 and12 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 de-crease(P＜0.05),and the VAS score of the three groups at12 h after surgery was higher than that at1 h after surgery(P＜0.05),and the VAS score of the three groups at6 and12 h after surgery was lower than that of group B(P＜0.05).Com-pared 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 with T1 and T2,the heart rate of group C at T3 and T4 was increased(P＜0.05),and the heart rate of group A and B at T3 and T4 was lower than that of group C(P＜0.05).Compared with T1,plasma levels of adrenalin,adrenocorticotropic hormone(ACTH),cortisol and nor-epinephrine(NA)in groups A,B and C were gradually increased at T3 and T4(P＜0.05).At T3 and T4,the plasma levels of adrenalin,ACTH,cortisol and NA in group B were lower than those in groups A and C,and lower in group A than in group C(P＜0.05).The incidence of hypertension and tachycardia in groups A and B was lower than that in group C at1 d follow-up,and the incidence of hypotension and bradycardia in groups A and C was lower than that in group B(P＜0.05,P＜0.01).Conclusion Compared with 1.00 μg/kg Dexmedetomidine,0.50 μg/kg Dexmedetomidine can improve the quality of recovery in patients with open total hysterectomy,play a better sedative and analgesic effect,reduce the intraoperative stress response of patients,maintain a stable hemodynamic state,and has good safety.
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