张文钰;卢焱;王玥;车向明;

• 1:首都医科大学附属北京妇产医院麻醉科

摘要(Abstract)：

目的分析右美托咪定对行宫颈癌根治术且合并高血压的患者围术期血压、心率及苏醒质量的影响。方法将本院2016年1月至2017年1月收治的97例行宫颈癌根治术且合并高血压的患者随机分为观察组(47例)和对照组(50例),观察组患者采用右美托咪定+丙泊酚+瑞芬太尼+罗库溴铵联合麻醉,对照组患者采用丙泊酚+瑞芬太尼+罗库溴铵麻醉。比较两组患者不同时间点的收缩压、舒张压及心率、手术时间、睁眼时间、拔管时间、视觉模拟评分法(visual analogue scale,VAS)评分以及手术医师的术中满意度。结果麻醉前,两组患者的收缩压、舒张压及心率比较均无显著差异(P>0.05);气管插管时、气腹起始、气腹后15分钟、气腹后30分钟,观察组患者的收缩压、舒张压及心率均显著低于对照组(P<0.05)。两组患者手术时间比较无显著差异(P>0.05),观察组患者睁眼时间和拔管时间均显著短于对照组(P<0.05),拔管后10分钟VAS评分显著低于对照组(P<0.05),手术医师术中总满意率显著高于对照组(P<0.05)。结论对于行宫颈癌根治术且合并高血压的患者,右美托咪定+丙泊酚+瑞芬太尼+罗库溴铵联合麻醉效果满意,稳定术中患者的血压和心率,有助于患者尽快苏醒,安全性较高。

关键词(KeyWords)： 右美托咪定;高血压;宫颈癌根治术

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 张文钰;卢焱;王玥;车向明;

参考文献(References)：

• [1]王梦,程亮亮.舒芬太尼与芬太尼对宫颈癌手术麻醉效果的比较[J].海南医学,2015,26(16):2462-2463.
• [2]Mueller SW,Preslaski CR,Kiser TH,et al.A randomized,double-blind,placebo-controlled dose range study of dexmedetomidine as adjunctive therapy for alcohol withdr awal[J].Crit Care Med,2014,42(5):1131-1139.
• [3]郑江美,平永美,周华锋.右美托咪定对宫颈癌切除术全麻患者苏醒期躁动作用的影响[J].中国生化药物杂志,2016,36(9):78-81.
• [4]梅静,马冬梅,冯琦.舒芬太尼对宫颈癌手术患者术后苏醒质量和T细胞功能的影响[J].中国老年学杂志,2014,34(22):6312-6314.
• [5]顾颖红,周期,李敏仙.合并心血管疾病的老年患者68例围麻醉期处理[J].中国老年病杂志,2010,30(8):2228-2229.
• [6]庞留成.右美托咪啶用于宫颈癌根治术麻醉后对患者早期认知功能的影响分析[J].现代中西医结合杂志,2014,23(14):1570-1571.
• [7]Funai Y,Pickering AE,Uta D,et al.Systemic dexmedetomidine augments inhibitory synaptic transmission in the superficial dorsal horn through activation of descending noradrenergic control:an in vivo patch-clamp analysis of analgesic mechanisms[J].Pain,2014,155(3):617-628.
• [8]Li SS,Zhang WS,Ji D,et al.Involvement of spinal microglia and interleukin-18 in the anti-nociceptive effect of dexmedetomidine in rats subjected to CCI[J].Neurosci Lett,2014,560:21-25.
• [9]曾和清,易理生,肖文军.持续静注右美托咪定对腹腔镜下宫颈癌根治术患者全麻恢复期的影响[J].实用肿瘤学杂志,2016,30(2):135-139.
• [10]Frazee EN,Personett HA,Leung JG,et al.Influence of dexmedetomidine therapy on the management of severe alcohol withdrawal syndrome in critically ill patients[J].J Crit Care,2014,29(2):298-302.
• [11]Zhang L,Fan Y,Wu Y.Inositol based non-viral vectors for transgene expression in human cervical carcinoma and hepatoma cell lines[J].Biomaterials,2014,35(6):2039-2050.
• [12]Vale DB,Braganca JF,Morais SS,et al.Protection against squamous cell carcinoma and cervical adenocarcinoma afforded by cervical cytology screening:a cross-sectional study[J].Int J Gynecol Cancer,2014,24(2):321-328.
• [13]Hunt JR,Slingsby LS,Murrell JC.The effects of an intravenous bolus of dexmedetomidine following extubation in a mixed population of dogs undergoing general anaesthesia and surgery[J].Veterinary Journal,2014,200(1):133-139.
• [14]Brocker KA,Alt CD,Gerhard G,et al.Magnetic resonance imaging of cervical carcinoma using an endorectal surface coil[J].Eur J Radiol,2014,83(7):1030-1035.
• [15]Wang Y,Zhu Y,Jiang H,et al.Propofol and dexmedetomidine for monitored anesthesia care during laser in situ keratomileusis[J].Eye&Contact Lens,2014,40(1):12-16.
• [16]王向阳,赵晶,张伟,等.右美托咪定联合舒芬太尼用于术后镇痛对宫颈癌根治术患者心血管稳定性及VAS评分的影响[J].中国妇幼健康研究,2017,28(5):606-608.
• [17]El-Tahan MR,Mowafi HA,Al Sheikh IH,et al.Efficacy of dexmedetomidine in suppressing cardiovascular and hormonal rsponses to general anesthesia for caesarean delivery:a doseresponse study[J].Int J Obstet Anesth,2012,21(3):222-229.
• [18]Haselman MA.Dexmedetomidine:a useful adjunct to consider in some high-risk situations[J].AANA J,2008,76(5):335-339.
• [19]王庭国,彭俊旭,桑軼娜,等.右美托咪啶对老年高血压患者全身麻醉诱导期血流动力学的影响[J].中国医药科学,2015,5(19):169-171,182.
• [20]Xin J,Zhang Y,Zhou L,et al.Effect of dexmedetomidine infusion for intravenous patient-controlled analgesia on the quality of recovery after laparotomy surgery[J].Oncotarget,2017,8(59):100371-100383.