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目的探讨右美托咪定减轻人工流产(人流)术中手术应激反应的效果。方法接受无痛人流术患者80例,均采用丙泊酚2mg/kg麻醉。随机均分为四组:D1组麻醉诱导前10min内输注右美托咪定0.5μg/kg;D2组术中持续输注右美托咪定0.2μg·kg~(-1)·h~(-1)至手术结束;D3组于麻醉诱导前10min内输注右美托咪定0.5μg/kg,其后持续输注右美托咪定0.2μg·kg~(-1)·h~(-1)至手术结束;C组不用右美托咪定作为对照。记录麻醉前(T1)、手术开始(T2)、扩宫颈(T3)和术毕(T4)的MAP、HR、SpO_2和脑电双频指数(BIS)。检测T1~T4时的血浆肾上腺素(E)、去甲肾上腺素(NE)和皮质醇(Cor)浓度。结果 D1、D2和D3组术中T2~T4时MAP、HR、BIS值和丙泊酚用量均低于C组(P<0.05)。D1、D2和D3组术中T2~T4时血浆E、NE和Cor浓度均低于C组(P<0.05)。D3组的以上变化较D1和D2组更为明显(P<0.05)。结论右美托咪定可明显减轻人流手术患者的应激反应,增强丙泊酚麻醉效果,维持循环稳定,提高苏醒质量。
Objective To investigate the effect of dexmedetomidine in reducing surgical stress during abortion (abortion). Methods Eighty patients with painless abortion were anesthetized with propofol 2mg / kg. The patients in group D1 were treated with dexmedetomidine 0.5 μg / kg within 10 minutes before induction of anesthesia. Patients in group D2 received continuous dexmedetomidine infusion 0.2 μg · kg -1 (-1) h ~ (-1) to the end of surgery; group D3 was given dexmedetomidine 0.5 μg / kg within 10 minutes before induction of anesthesia, and then received continuous infusion of dexmedetomidine 0.2 μg · kg -1 · h ~ (-1) to the end of surgery; group C did not use dexmedetomidine as a control. The MAP, HR, SpO 2 and BIS were recorded before anesthesia (T1), at the beginning of surgery (T2), at the cervix (T3) and at the end of surgery (T4) Plasma levels of epinephrine (E), norepinephrine (NE) and cortisol (Cor) were measured at T1-T4. Results The MAP, HR, BIS and propofol dosage in T2, T4 and T4 groups were lower than those in C group (P <0.05). The concentrations of plasma E, NE and Cor in group D1, D2 and D3 were lower than those in group C at T2 ~ T4 (P <0.05). The above changes in D3 group were more obvious than those in D1 and D2 groups (P <0.05). Conclusion Dexmedetomidine can significantly reduce the stress response in patients undergoing abortion, enhance the anesthetic effect of propofol, maintain the circulation stability and improve the quality of wakefulness.