摘要
目的:探究子宫肌瘤(UF)手术应用右美托咪定复合氯胺酮麻醉方案对患者围术期的影响。方法:筛选2023年1-12月在本院行腹腔镜子宫肌瘤剔除术(LM)的UF患者328例,采用双盲法分为两组各164例,对照组采取氯胺酮进行术中麻醉,观察组在对照组基础上应用右美托咪定进行全身麻醉,对比两组麻醉质量(苏醒时间、术中出血量及拔管后30min的Steward苏醒评分)、术后睡眠与恢复情况[匹兹堡睡眠质量指数量表(PSQI)评分、40项恢复质量量表(QoR-40)评分]、疼痛因子水平[β-内啡肽(β-EP)、P-物质(SP)]、应激反应[去甲肾上腺素(NE)、皮质醇(Cor)]及不良反应发生情况。结果:观察组苏醒时间(9.7±2.1min)及术后30min的Steward苏醒评分(4.79±0.36分)均低于对照组(12.4±2.7min、5.28±0.57分),术后24h、术后48hPSQI评分(13.96±2.08分、10.83±1.46分)均低于对照组(14.65±2.49分、12.75±2.04分),QoR-40评分(182.79±4.61分、193.88±2.56分)均高于对照组(178.62±5.12分、186.39±3.71分),术后3d血清β-EP(154.68±23.42pg/ml)、SP(2.46±0.85μg/ml)水平低于对照组(181.36±24.67pg/ml、5.23±1.14μg/ml),术后1d血清NE(317.92±22.86ng/L)、Cor(161.57±36.40ng/ml)水平均低于对照组(339.46±25.61ng/L、181.64±39.83ng/ml),不良反应总发生率(3.7%)低于对照组(10.4%)(均P<0.05)。结论:采用LM术UF患者应用右美托咪定与氯胺酮的联合方案进行麻醉,可提升苏醒质量、改善术后睡眠并促进恢复,对术后疼痛与围术期应激反应均具有减轻作用,临床应用安全可靠。
Objective:To investigate the safety of dexmedetomidine combined with ketamine for anesthesia of the surgery of patients with uterine fibroids(UF).Methods:A total of 328 patients with UF who wanted LM in the hospital were selected and were divided into two groups(164 cases in each group)from January 2023 to December 2023.The patients in the two groups were given ketaminefor anesthesia,and the patients in the observation group were given dexmedetomidine general anesthesia additionally.The anesthesia quality,such as the recovery time,the intraoperative blood loss and the Steward recovery score at 30o min after extubation,the postoperative sleep evaluated by Pittsburgh sleep quality index(PSQI)score,the awaken quality evaluated by recovery scale 4o(QoR-40)score,the levels of the pain factors,such asβ-endorphin(β-EP)and substance P(SP),the stress response evaluated by the levels of norepinephrine(NE)and cortisol(Cor),and the adverse reactions rate of the patients were compared between the two groups.Results:The recovery time(9.7±2.1 min)and the Steward recovery score at 30min after operation(4.79±0.36 points)of the patients in the observation group were significantly lower than those(12.4±2.7 min and 5.28±0.57 points)of the patients in the control group.The PSQI scores of the patients in the observation group at 24h and 48h after operation(13.96±2.08 points and 10.83±1.46 points)were significantly lower than those(14.65±2.49 points and 12.75±2.04 points)of the patients in the control group.The QoR-40 scores of the patients in the observation group at 24h and 48h after operation(182.79±4.61 points and 193.88±2.56 points)of the patients in the observation group were significantly higher than those(178.62±5.12 points and 186.39±3.71 points)of the patients in the control group.The serum levels ofβ-EP(154.68±23.42 pg/ml)and SP(2.46±0.85μg/ml)of the patients in the observation group in 3 days after operation were significantly lower than those(181.36±24.67 pg/ml and 5.23±1.14μg/ml)of the patients in the control group.The levels of the serum NE(317.92±22.86 ng/L)and Cor(161.57±36.40 ng/ml)of the patients in the observation group in 1 day after operation were significantly lower than those(339.46±25.61 ng/L and 181.64±39.83 ng/ml)of the patients in the control group.The total incidence of the adverse reactions(3.7%)of the patients in the observation group was significantly lower than that(10.4%)of the patients in the control group(all P<0.05).Conclusion:The combination of dexmedetomidine and ketamine for anesthesia of patients with UF during LM can improve their awaken quality and postoperative sleep,promote their postoperative recovery,relieve their postoperative pain and perioperative stress reaction,and which has the safety and reliable in the clinical application.
作者
胡淑婷
李岩
卢玉蓉
周晓晶
HU Shuting;LI Yan;LU Yurong;ZHOU Xiaojin(Yuncheng Central Hospital Affiliated to Shanri Medical University,Yuncheng,Shanri Province,044000)
出处
《中国计划生育学杂志》
2025年第1期72-78,共7页
Chinese Journal of Family Planning
