孙雪峰

【摘要】 目的：探究右美托咪定不同注射方法复合全身麻醉在腹腔镜子宫切除术中的应用效果及安全性。方法：选取2020年10月—2022年10月天津市东丽医院收治的92例接受腹腔镜子宫切除术的患者，使用随机数字表法将其分为三组，A组（n=32）接受全身麻醉，B组（n=30）接受持续泵注右美托咪定，C组（n=30）接受单次注射右美托咪定。对比三组患者入室后（T0）、麻醉后5 min（T1）、气管插管（T2）、术后即刻（T3）、术后24 h（T4）血流动力学水平、血糖、纤溶系统指标水平、应激反应，以及麻醉效果、不良反应。结果：T1、T2、T3、T4相較T0，三组HR、MAP均升高，C组T1、T2、T3、T4的HR、MAP均低于B组、A组，B组均低于A组（P<0.05）。C组T2、T3、T4的血糖、D-D、PAI-1、t-PA均低于B组、A组，B组均低于A组（P<0.05）。C组自主呼吸恢复时间、拔管时间、苏醒时间均早于B组、A组，B组均早于A组（P<0.05）。三组不良反应发生率比较，差异有统计学意义（字2=8.276，P=0.002）；A组、B组的不良反应发生率（37.50%、26.67%）均高于C组（6.67%）（P<0.05）。结论：单次注射右美托咪定用于腹腔镜下子宫切除术中，麻醉效果显著，可稳定患者血流动力学，对患者纤溶系统影响较小，降低应激反应，安全性较高。

【关键词】 右美托咪定 不同注射方法 复合全身麻醉 腹腔镜子宫切除术 安全性

Application Effect of Different Injection Methods of Dexmedetomidine Combined with General Anesthesia in Laparoscopic Hysterectomy/SUN Xuefeng. //Medical Innovation of China， 2024， 21（08）： -116

[Abstract] Objective： To explore the efficacy and safety of different injection methods of Dexmedetomidine combined with general anesthesia in laparoscopic hysterectomy. Method： A total of 92 patients undergoing laparoscopic hysterectomy admitted to Tianjin Dongli Hospital from October 2020 to October 2022 were selected， group A （n=32） received general anesthesia， group B （n=30） received continuous pump Dexmedetomidine， and group C （n=30） received a single injection of Dexmedetomidine. The hemodynamic levels， blood glucose and fibrinolytic system indexes， stress response after entry （T0）， 5 min after anesthesia （T1）， tracheal intubation （T2）， immediately after surgery （T3）， 24 h after surgery （T4）， anesthesia effect and adverse reactions of the three groups were compared. Result： Compared with T0， HR and MAP of T1， T2， T3 and T4 in the three groups were all increased， and HR and MAP of T1， T2， T3 and T4 in group C were lower than those in group B and group A， and those in group B were lower than those in group A （P<0.05）. The blood glucose levels， D-D， PAI-1 and t-PA at T2， T3， T4 in group C were lower than those in group B and group A， and those in group B were lower than those in group A （P<0.05）. The recovery time of spontaneous respiration， extubation time and recovery time of group C were earlier than those of group B and group A， and those in group B were earlier than those in group A （P<0.05）. The incidence of adverse reactions among the three groups was statistically significant （字2=8.276， P=0.002）; the incidence of adverse reactions in group A （37.50%） and group B （26.67%） were higher than that in group C （6.67%） （P<0.05）. Conclusion： Single injection of Dexmedetomidine in laparoscopic hysterectomy has significant anesthetic effect， can stabilize the hemodynamics of patients， has little impact on the fibrinolytic system of patients， reduces stress response， and is safe.

[Key words] Dexmedetomidine Different injection methods Compound general anesthesia Laparoscopic hysterectomy Safety

First-author's address： Department of Anesthesiology， Tianjin Dongli Hospital， Tianjin 300300， China

doi：10.3969/j.issn.1674-4985.2024.08.025

随着医疗技术的快速发展，腹腔镜微创技术逐渐被应用在临床中，且在子宫切除术中该技术已经非常成熟[1]。应用腹腔镜技术需要在术中使用CO2建立气腹，导致患者循环呼吸系统受到影响，血压、心率因此升高，进而发生应激反应[2]。所以，腹腔镜手术术前选择适当的麻醉方式意义显著。有研究显示，下肢骨折、ICU颅脑损伤术后通气中应用右美托咪定复合全麻，患者指标平稳，可减轻患者心血管反应，麻醉效果显著[3]。但该麻醉药物在腹腔镜子宫全切手术中报道较少，给药方案有待研究。因此，本研究使用平行对照法对比右美托咪定不同注射方法复合全身麻醉在腹腔镜子宫切除术中效果及安全性，具体如下。

1 资料与方法

1.1 一般资料

选取2020年10月—2022年10月天津市东丽医院收治的92例接受腹腔镜子宫切除术的患者，纳入标准：（1）ASA分级Ⅰ、Ⅱ级[4]。……