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目的探讨右美托咪定用于子宫肌瘤剔除术的麻醉效果。方法选取2015年10月-2017年3月在该院行腹腔镜子宫肌瘤剔除术的子宫肌瘤患者160例,按随机数字表法将其分为A组(80例)和B组(80例),A组采用右美托咪定麻醉,B组采用丙泊酚麻醉。比较两组血压和心率(HR)的波动性、麻醉深度、镇静效果、应激反应及不良反应。结果A组、B组切皮时至术毕的平均动脉压(MAP)、HR水平升高,A组MAP、HR水平升高幅度较小,B组MAP和HR水平明显升高(P<0.05),A组切皮时、剔除肌瘤时、缝合时和术毕的MAP和HR水平明显低于B组(P<0.05);A组、B组的术中脑电双频指数(BIS)值下降、Ramsay镇静评分升高,A组手术开始后0.5 h的BIS值明显高于B组(P<0.05),A组手术开始后0.5 h的镇静评分明显低于B组(P<0.05);A组、B组切皮时至缝合时的皮质醇(Cor)、肾上腺素(E)和血糖值(GLU)水平升高,A组Cor、E和GLU水平升高幅度较小,B组Cor、E和GLU水平明显升高(P<0.05),A组切皮时、剔除肌瘤时、缝合时的Cor、E和GLU水平明显低于B组(P<0.05);A组、B组手术开始后0.5 h的超氧离子(O_2~-)、羟自由基(OH)、过氧化氢(H_2O_2)、肾上腺素(MDA)水平升高且超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平下降,A组手术开始后0.5 h、术后24 h的O_2~-、OH、H_2O_2和MDA水平明显低于B组,且SOD、GSH-Px水平明显高于B组(P<0.05);A组、B组的不良反应发生率为5.00%、12.50%,组间比较差异无统计学意义(P>0.05)。结论右美托咪定有助于稳定术中血压和HR、优化麻醉深度和镇静质量、抑制应激水平升高,副作用少,适用于子宫肌瘤剔除术。
Objective To investigate the anesthetic effect of dexmedetomidine for myomectomy. Methods A total of 160 patients with uterine leiomyoma who underwent laparoscopic myomectomy in our hospital from October 2015 to March 2017 were divided into group A (80 cases) and group B (80 cases) according to the random number table Cases), A group with dexmedetomidine anesthesia, B group with propofol anesthesia. Blood pressure and heart rate (HR) variability, depth of anesthesia, sedation, stress and adverse reactions were compared between the two groups. Results The mean arterial pressure (MAP) and HR of group A and group B were increased from the time of skin incision to the end of operation, the level of MAP and HR increased slightly in group A and the level of MAP and HR in group B was significantly increased (P <0.05 ). In group A, the MAP and HR levels at the time of suturing and surgery were significantly lower than those in group B (P <0.05), and the intraoperative EEG index (BIS) (P <0.05). The sedation score of 0.5 h after the start of operation in group A was significantly lower than that in group B (P <0.05) (Cor), epinephrine (E) and blood glucose (GLU) levels in group A and group B were significantly higher than those in group C Cor, E and GLU in group A were significantly lower than those in group B (P <0.05). Group A, B After 0.5 h of operation, the content of O 2 -, OH, H 2 O 2 and adrenaline (MDA) in the group at the beginning of the operation were increased. The levels of superoxide dismutase (SOD), glutathione The level of GSH-Px decreased, the levels of O 2 -, OH, H 2 O 2 and MDA at 0.5 h after operation in group A and 24 h after operation (P <0.05). The incidence of adverse reactions in group A and group B was 5.00% and 12.50%, respectively, with no significant difference between the two groups (P <0.05) P> 0.05). Conclusion Dexmedetomidine helps to stabilize intraoperative blood pressure and HR, optimize depth of anesthesia and calming quality, inhibit the increase of stress level and reduce the side effects. It is suitable for myomectomy.