摘要
目的比较右美托咪定与丙泊酚复合舒芬太尼用于宫腔镜诊刮术麻醉的临床效果及安全性。方法选取2019年6—12月北京市平谷区医院妇科进行宫腔镜诊刮术的84例患者,采用随机数字表法分为右美托咪定复合舒太尼组(D组)和丙泊酚复合舒芬太尼组(P组),每组42例。D组术前10 min静脉泵入右美托咪定负荷量1μg/kg,后以0.2~0.6μg/(kg·h)维持;P组术前2 min静脉缓慢推注丙泊酚负荷量1.5 mg/kg,后以4~6 mg/(kg·h)维持。所有患者于术前5 min静注推注舒芬太尼0.15μg/kg,分别于麻醉前(T_(0))、扩宫颈时(T_(1))、刮宫时(T_(2))、术毕时(T_(3))和意识恢复时(T_(4))5个时点记录患者小波指数(wavelet index,WLi)、镇痛指数(pain threshold index,PTi)、平均动脉压(mean arterial pressure,MAP)、HR和SpO_(2);记录术中及术后不良反应、术后意识恢复时间及术后宫缩痛等情况。结果与P组比较,D组在T_(1)~T_(4)时点的WLi、PTi、MAP和SpO_(2)显著升高,HR显著下降,差异均有统计学意义(P<0.05);D组术中注射痛、呼吸抑制发生率明显低于P组(0.0%比64.3%,0.0%比16.7%),体动发生率明显高于P组(19.0%比2.4%),追加丙泊酚的比例明显高于P组(19.0%比2.4%),提下颌或面罩加压给氧的比例明显低于P组(0.0%比16.7%),差异均有统计学意义(P<0.05);两组恶心呕吐发生率和术后宫缩痛评分比较,差异无统计学意义(P>0.05)。D组意识恢复时间明显短于P组[2.0(1.0,3.0)s比84.5(32.8,122.5)s],差异有统计学意义(P<0.05)。结论右美托咪定复合舒芬太尼用于宫腔镜诊刮术麻醉具有循环稳定,无注射痛、无呼吸抑制及意识恢复快等优点,但体动情况多见,需要进一步研究。
Objective To compare the clinical efficacy and safety of dexmedetomidine and propofol combined with sufentanil in hysteroscopic curettage anesthesia.Methods A total of 84 patients underwent hysteroscopic curettage in Department of Gynecology,Beijing Pinggu Hospital from June to December 2019 were selected and divided into dexmedetomidine combined with sufentanil group (group D) and propofol combined with sufentanil group (group P)by random number table method,with 42 patients in each group.The D group received infusion of 1.0μg/kg dexmedetomidine 10 minutes before operation,followed by continuous pump infusion of dexmedetomidine at 0.2-0.6μg/(kg·h).In group P,propofol was slowly infused intravenously with 1.5 mg/kg 2 minutes before operation,and then maintenance at 4-6 mg/(kg·h).All patients received a bolus injection of sufentanil 0.15μg/kg 5 minutes before operation.The wavelet index (WLi),pain threshold index (PTi),mean arterial pressure (MAP),HR and SpO_(2) were recorded at five time points of before anesthesia (T_(0)),cervical dilation (T_(1)),curettage (T_(2)),post-operation (T_(3)) and consciousness recovery (T;).The intraoperative and postoperative adverse reactions,postoperative consciousness recovery time and postoperative uterine contraction pain were recorded.Results Compared with group P,WLi,PTi,MAP and SpO_(2)in group D were significantly increased at the time point of T_(1)-T_(4),and HR decreased significantly,and the differences were statistically significant (P<0.05).The incidence of intraoperative injection pain and respiratory depression in group D were significantly lower than those in group P (0.0%vs.64.3%,0.0%vs.16.7%),the incidence of body movement was significantly higher than that in group P (19.0%vs.2.4%),the proportion of additional propofol was significantly higher than that in group P (19.0%vs.2.4%),and the proportion of oxygen supply with mandibular lift or mask was significantly lower than that in group P (0.0%vs.16.7%),the differences were statistically significant(P<0.05).There was no significant difference in the incidence of nausea and vomiting and postoperative uterine contraction pain score between the two groups (P>0.05).The recovery time of consciousness in group D was significantly shorter than that in group P[2.0(1.0,3.0) s vs.84.5(32.8,122.5) s],the difference was statistically significant(P<0.05).Conclusions Dexmetomidine combined with sufentanil for hysteroscopic curettage anesthesia has the advantages of stable circulation,no injection pain,no respiratory depression and rapid recovery of consciousness,but the body movement is common and needs further study.
作者
张志佳
吴安石
Zhang Zhijia;Wu Anshi(Department of Anesthesiology,Beijing Pinggu Hospital,Beijing 101200,China)
出处
《北京医学》
CAS
2022年第4期322-326,共5页
Beijing Medical Journal
关键词
右美托咪定
丙泊酚
小波指数
镇痛指数
宫腔镜
dexmedetomidine
propofol
wavelet index(WLi)
pain threshold index(PTi)
hysteroscopy
