摘要
目的通过观察围手术期血流动力学及炎症因子水平变化,探讨不同剂量右美托咪定在妇科腹腔镜手术中的应用。方法选择2013年6月至2016年4月120例行妇科腹腔镜手术患者,随机分为右美托咪定高剂量组(A1)、右美托咪定低剂量组(A2)及对照组(C),每组40例,A1、A2组分别于麻醉诱导后输注右美托咪定0.8μg·kg-1·h-1、0.4μg·kg-1·h-1,C组给予等量生理盐水,分别于麻醉诱导前10min(T0)、气管插管后1min(T1)、气腹后5 min(T2)、术毕(T3)不同时间点观察各组患者心率(HR)、平均动脉压(MAP)、去甲肾上腺素(NE)及血清IL-6、IL-10、TNF-α水平变化。结果 3组患者在T1、T2时间点MAP、HR、NE均有显著性差异(F值3.23~5.47,均P<0.05),T3时间点HR、NE有显著性差异(F值分别为3.27、3.76,均P<0.05),而MAP无显著性差异(F=1.09,P>0.05),A1在不同时间点MAP、HR、NE均波动最小,C组患者波动最大。3组患者在T1、T2、T3时间点IL-6、IL-10、TNF-α均有显著性差异(F值3.31~5.58,均P<0.05),A1组患者T1、T2、T3时间点IL-6、TNF-α水平均最低,IL-10水平最高,而C组患者IL-6、TNF-6α水平均最高,IL-10水平最低。3组患者气腹时间、麻醉恢复时间均无显著性差异(F值分别为0.559、1.677,均P>0.05)。结论妇科腹腔镜手术中应用右美托咪定可减轻围手术期炎症反应,有利于维持血流动力学稳定,其中0.8μg·kg-1·h-1作用显著。
Objective To explore the effect of different doses of dexmedetomidine on perioperative hemodynamics and inflammatory factors in gynecologic laparoscopic surgery. Methods A total of 120 patients undergoing gynecological laparoscopic surgery during the period of June 2013 to April 2016 were selected and were randomly divided into high dose group （ A1 ）, low dose group （A2） and control group （ C ） with 40 cases in each. Patients in group A1 and group A2 were given 0.8μg/（ kg. h） and 0.4μg/（ kg. h） of dexmedetomidine after induction of anesthesia, respectively. Patients in group C were given saline solution. Heart rate （ HR）, mean arterial pressure （ MAP）, norepinephrine （NE）, IL-6, IL-10 and TNF-ot in serum were observed in each group at different time points of 10 min before anesthesia （T0）, 1 min after tracheal intubation （ T1 ）, 5 min after pneumoperitoneum （T2） and the end of the surgery （ 33 ）. Results MAP, HR and NE were significantly different among three groups of patients in T1 and T2 （ F value ranged 3.23 to 5.47, respectively, all P 〈 0.05 ）. HR and NE had significant differences （F value was 3.27 and 3.76, respectively, both P 〈 0.05）, while there was no significant difference in MAP at T3 （ F = 1.09, P 〉 0.05 ）. MAP, HR and NE waves were minimum in group A1 while most volatile in group C at different time points. Three groups of patients were significantly different at T1, T2 and T3 in IL-6, IL-10 and TNF-α （ F value ranged 3.31 to 5.58, respectively, all P 〈 0.05 ）. At T1, T2 and 33 IL-6 and TNF-α were lowest but IL-10 was highest in group A1, while IL- 6 and TNF-α were highest, but IL-10 was lowest in group C. Three groups of patients were not significantly different in pneumoperitoneum time and anesthesia recovery time （ F value was 0.559 and 1. 677, respectively, both P 〉 0.05 ）. Conclusion Use of dexmedetomidine in gynecological laparoscopic surgery can reduce the perioperative inflammatory response, which is helpful to maintain hemodynamic stability. The dose of 0.8μg/（ kg. h） is significant.
出处
《中国妇幼健康研究》
2017年第2期190-193,共4页
Chinese Journal of Woman and Child Health Research
关键词
腹腔镜
右美托咪定
炎症因子
血流动力学
laparoscopy
dexmedetomidine （DEX）
inflammatory cytokines
hemodynamics
作者简介
戎小萍（1977-），女，副主任医师，主要从事妇产科麻醉工作。
