摘要
目的探讨右美托咪定联合舒芬太尼对高强度聚焦超声(HIFU)消融治疗子宫疾病患者疼痛、镇静及应激反应的影响。方法选取2021年12月—2023年6月150例拟行HIFU消融治疗的子宫疾病(子宫肌瘤或子宫腺肌症)患者,术中均行清醒镇静镇痛麻醉,采用电脑随机数字表法分为S组和D组,每组75例。S组采用舒芬太尼麻醉,D组采用右美托咪定联合舒芬太尼麻醉。比较2组麻醉前(T0)、麻醉后10 min(T1)、麻醉后20 min(T2)、麻醉后30 min(T3)、麻醉后60 min(T4)、手术结束即刻(T5)视觉模拟评分法(VAS)评分、Ramsay镇静评分、应激指标[5-羟色胺(5-HT)、去甲肾上腺素(NE)、皮质醇(Cor)],观察2组术中爆发痛、舒芬太尼追加情况、麻醉满意度、术后清醒状态及不良反应发生情况。结果T1~T5时2组VAS评分、Ramsay镇静评分呈先升高后降低趋势,且D组低于S组(P<0.05)。D组爆发痛次数、舒芬太尼追加次数均少于S组,麻醉满意度评分及术后清醒状态评分均高于S组(P<0.05)。T3和T5时D组5-HT、NE、Cor水平低于S组(P<0.05)。D组不良反应发生率2.67%(2/75)低于S组的13.33%(10/75)(P<0.05)。结论右美托咪定联合舒芬太尼用于子宫疾病HIFU消融治疗能进一步减轻疼痛及应激反应,提高镇静镇痛效果,促进术后清醒状态,提高患者满意度,且能降低不良反应发生率。
Objective To investigate the effects of Dexmedetomidine combined with Sufentanil on pain,sedation and stress response in patients with uterine diseases treated by high intensity focused ultrasound(HIFU)ablation.Methods From December 2021 to June 2023,patients with uterine diseases(uterine fibroids or adenomyosis)who planned to undergo HIFU ablation were selected and given sober sedation,analgesia and anesthesia during the operation.They were divided into group S and group D by computer random number table method,with 75 patients in each group.Group S was anesthetized with Sufentanil,and group D was anesthetized with Dexmedetomidine combined with Sufentanil.The visual analogue scale(VAS)score,Ramsay sedation score,stress indexes[5-serotonin(5-HT),norepinephrine(NE),cortisol(Cor)]before anesthesia(T0),at 10 min after anesthesia(T1),at 20 min after anesthesia(T2),at 30 min after anesthesia(T3)and at 60 min after anesthesia(T4),and immediately after operation(T5)were compared between the two groups.Intraoperative pain outbreak,supplementation of Sufentanil,satisfaction with anesthesia,postoperative wakefulness and occurrence of adverse reactions were observed in the two groups.Results At T1-T5,VAS and Ramsay sedation scores of the two groups were increased first and then decreased,which were lower in group D than in group S(P<0.05).The frequency of pain outbreak and Sufentanil addition in group D were lower than those in group S,and the scores of anesthesia satisfaction and postoperative wakefulness were higher than those in group S(P<0.05).The levels of 5-HT,NE and Cor in group D were lower than those in group S at T3 and T5(P<0.05).The incidence of adverse reactions in group D was 2.67%(2/75),which was lower than that in group S 13.33%(10/75)(P<0.05).Conclusion Dexmedetomidine combined with Sufentanil for HIFU ablation of uterine diseases can further reduce pain and stress response,improve sedation and analgesia,promote postoperative wakefulness,improve patient satisfaction,and reduce the incidence of adverse reactions.
作者
张鑫淼
王艳青
刘永芳
尹东杰
王继新
崔富春
ZHANG Xinmiao;WANG Yanqing;LIU Yongfang;YIN Dongjie;WANG Jixin;CUI Fuchun(Department of Anesthesia,Hebei Reproductive Obstetrics and Gynecology Hospital,Shijiazhuang 050000,China)
出处
《临床误诊误治》
CAS
2023年第12期105-109,共5页
Clinical Misdiagnosis & Mistherapy
基金
河北省卫生健康委员会医学科学研究项目(20231710)
石家庄市科学技术研究与发展计划项目(211200883)。
