贵州医科大学学报

2019, v.44;No.220(01) 81-85+104

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右美托咪定与芬太尼对无痛人流患者血清应激激素水平和血流动力学的影响
Comparison of Effects of Dexmedetomidine and Fentanyl on Stress Hormones and Hemodynamics in Painless Abortion

张引吉;翁浩;高玉蓓;付子毅;
ZHANG Yinji;WENG Hao;GAO Yubei;FU Ziyi;Department of Anesthesiology,Central Hospital of Fengxian District;Nanjing Maternal and Child Health Hospital;

摘要(Abstract):

目的:探讨右美托咪定与芬太尼对无痛人流患者血清应激激素水平和部分血流动力学指标的影响。方法:75例行无痛人流术孕妇按入院顺序随机分为右美托咪定组(38例)和芬太尼组(37例),右美托咪定组给予静脉微量泵注右美托咪定0.5μg/kg,芬太尼组静脉缓慢注射芬太尼注射液1μg/kg,两组患者都给与丙泊酚2 mg/kg静脉推注;检测两组患者术前和术后1 h内的应激激素[皮质醇(Cor)、肾素(Rn)、血管紧张素Ⅰ(A-Ⅰ)、血管紧张素Ⅱ(A-Ⅱ)和促肾上腺皮质激素(ACTH)],记录给药前(T0)、给药后2 min(T1)、扩张宫颈时(T2)及苏醒时(T3)的平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)、心率(HR)和氧饱和度(Sp O2)],术后0.5 h内的Ramsay镇静评分、唤醒时间、定向力恢复时间和镇痛效果。结果:两组患者术前血清A-Ⅰ、A-Ⅱ、ACTH、Cor和Rn水平差异无统计学意义(P>0.05),术后1 h内,与芬太尼组比,右美托咪定组A-Ⅰ、A-Ⅱ、ACTH和Rn均明显降低(P<0.05),Cor明显增高(P<0.05);两组患者手术T0时的BP、HR和Sp O2差异无统计学意义(P>0.05),T1、T2和T3时,与芬太尼组比,右美托咪定组的BP、HR和Sp O2明显增高(P<0.05);术后0.5 h内,与芬太尼组比,右美托咪定组的Ramsay镇静评分、唤醒时间和定向力恢复时间明显减少(P<0.05);与芬太尼组比,右美托咪定组的镇痛优良率较高(P<0.05),不良反应发生率较低(P<0.05)。结论:与芬太尼相比,右美托咪定对患者应激激素和血流动力学影响较小,镇痛效果好,安全性高。
Objective:To investigate and compare the effects of dexmedetomidine and fentanyl on stress hormones and hemodynamics in painless abortion.Methods:75 pregnant women undergoing painless abortion were randomly divided into dexmetomidine group(38 cases) and fentanyl group(37 cases).The dexmetomidine group was given intravenous injection of dexmetomidine 0.5 μg/kg,and the fentanyl group was slowly injected with 1 μg/kg fentanyl.Both groups were given intravenous injection of propofol 2 mg/kg.Stress hormones [cortisol(Cor),renin(Rn),angiotensin Ⅰ(A-Ⅰ),angiotensin Ⅱ(A-Ⅱ) and adrenocorticotropic hormone(ACTH) ]were measured before and within 1 hour after operation in both groups.The mean arterial pressure(MAP),systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR) and oxygen saturation(SpO2) were recorded before(T0) administration,2 minutes(T1) after administration,at dilation of cervix(T2) and during reviving(T3).Ramsay sedation score,wake-up time,recovery time of orientation and analgesic effects were observed 0.5 hour after operation.Results:There was no significant difference in serum A-Ⅰ,PA-Ⅱ,ACTH,Cor and Rn levels between the two groups before operation(P>0.05).Compared with fentanyl group,A-Ⅰ,A-Ⅱ,ACTH and Rn in dexmetomidine group significantly decreased(P<0.05),while Cor increased(P<0.05) in the dexmedetomidine group within 1 hour after operation.There was no significant difference in BP,HR and SpO_2 between the two groups at the time of T0(P>0.05).Compared with fentanyl group,the BP,HR and SpO2 obviously increased in dexmetomidine group at T1,T2 and T3(P<0.05).Within 0.5 h after operation,compared with fentanyl group,the Ramsay sedation score,wake-up time and orientation recovery time in dexmetomidine group significantly decreased(P<0.05);the excellent rate was higher than that of the dexmetomidine group(P<0.05),while adverse reaction rate was lower than that of the dexmetomidine group(P<0.05).Conclusion:Compared with fentanyl,dexmedetomidine has less effects on stress hormone and hemodynamics,better analgesic effect and higher safety.

关键词(KeyWords): 右美托咪定;芬太尼;流产,人工;镇痛;应激障碍;激素类;血流动力学
dexmedetomidine;fentanyl;abortion artificial;analgesia;hormones;hemodynamics

Abstract:

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基金项目(Foundation): 国家自然科学基金青年科学基金项目(81302304)

作者(Author): 张引吉;翁浩;高玉蓓;付子毅;
ZHANG Yinji;WENG Hao;GAO Yubei;FU Ziyi;Department of Anesthesiology,Central Hospital of Fengxian District;Nanjing Maternal and Child Health Hospital;

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DOI: 10.19367/j.cnki.1000-2707.2019.01.016

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