摘要
目的:观察右美托咪定在妇科腹腔镜手术中的应用效果,并探讨最佳用药时机。方法:前瞻性选取南阳市第一人民医院2021年12月—2023年9月收治的110例妇科腹腔镜手术患者为研究对象,采用计算机随机分组法分为A组(55例)和B组(55例),2组患者均采用右美托咪定辅助全麻,A组于麻醉诱导前10 min给药,B组于麻醉维持时给药,比较2组术后镇痛、镇静效果、手术应激情况、术后认知功能、肠道屏障功能。结果:A组术后1、3 h视觉模拟疼痛(VAS)评分[(3.66±0.25)分、(2.59±0.45)分]低于B组[(4.33±1.72)分、(3.43±0.74)分](P<0.05);术后1、3 h Ramsay镇静(RSS)评分[(4.11±0.26)分、(3.41±0.45)分]低于B组[(5.66±1.75)分、(4.28±1.49)分](P<0.05);A组术后72 h去甲肾上腺素(NE)、皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)水平[(42.25±10.36)μg/L、(282.36±20.72)nmol/L、(27.65±5.25)ng/L]均低于B组[(47.66±10.36)μg/L、(295.77±20.46)nmol/L、(30.45±5.18)ng/L](P<0.05);A组术后72 h简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分[(25.44±5.25)分、(25.82±5.31)分]均高于B组[(22.19±5.35)分、(22.32±5.33)分](P<0.05);A组术后72 h紧密连接蛋白claudin-1[(85.45±10.31)pg/mL]高于B组[(80.22±10.44)pg/mL],二胺氧化酶(DAO)[(4.88±1.29)ng/mL]低于B组[(5.61±1.79)ng/mL],差异有统计学意义(P<0.05)。结论:右美托咪定辅助全麻可增强妇科腹腔镜手术患者的麻醉镇痛、镇静效果,麻醉诱导前10 min给药的麻醉效果更佳,对减轻患者手术应激、术后认知障碍及胃肠损伤均有积极意义。
Objective:Observe the application of dexmedetomidine in gynecological laparoscopic surgery and explore the optimal timing of medication.Methods:This prospective study included 110 gynecological laparoscopic surgery patients admitted to the First People's Hospital of Nanyang City from December 2021 to September 2023.The patients were classified into Group A(55 cases)and Group B(55 cases)by computer randomization method,and both groups were treated with dexmedetomidine pretreatment and assisted general anesthesia.Group A was administered 10min before induction of anesthesia,and group B was administered during maintenance of anesthesia.Postoperative analgesia and sedation effects,operative stress,postoperative cognitive function and intestinal barrier function were compared between the two groups.Results:At different administration times of dexmedetomidine,the VAS scores of Group A at 1 hour and 3 hours postoperatively were(3.66±0.25)points and(2.59±0.45)points,lower than Group B[(4.33±1.72)points and(3.43±0.74)points];The RSS scores at 1 hour and 3 hours after surgery were(4.11±0.26)points and(3.41±0.45)points,lower than Group B[(5.66±1.75)points and(4.28±1.49)points];The NE,Cor,and AngⅡwithin 72 hours after surgery in Group A were(42.25±10.36)μg/L,(282.36±20.72)nmol/L,and(27.65±5.25)ng/L,lower than Group B[(47.66±10.36)μg/L,(295.77±20.46)nmol/L,(30.45±5.18)ng/L];The MMSE and MoCA scores within 72 hours after surgery in Group A were(25.44±5.25)points and(25.82±5.31)points,higher than Group B[(22.19±5.35)points and(22.32±5.33)points];Within 72 hours after surgery,the claudin-1(85.45±10.31)pg/ml in Group A was higher than Group B(80.22±10.44)pg/ml,the DAO(4.88±1.29)ng/ml was lower than Group B(5.61±1.79)ng/ml(P<0.05).Conclusion:Dexmedetomidine assisted general anesthesia can enhance the anesthetic,analgesic,and sedative effects of gynecological laparoscopic surgery patients.Compared with 10 minutes after surgery,the anesthesia effect of 10 minutes before surgery is better.It has a positive significance in reducing surgical stress,postoperative cognitive impairment,and gastrointestinal damage in patients.
作者
王培
张凤君
Wang Pei;Zhang Fengjun(Dept.of Anesthesia,the First People's Hospital of Nanyang,Henan,473000,China;:Dept.of Anesthesia,the Obstetrics and Gynecology Hospital o Kaifeng,Henan,475000,China)
出处
《淮海医药》
CAS
2024年第5期505-508,共4页
Journal of Huaihai Medicine
基金
河南省医学科技攻关项目(LHGJ20210162)。
关键词
腹腔镜手术
右美托咪定
妇科
麻醉效果
胃肠损伤
给药时机
Gynecological laparoscopic surgery
Dexmedetomidine
Anesthetic effect
Gastrointestinal injury
Administration timing
