张引吉,翁浩,高玉蓓,付子毅
ZHANG Yinji,WENG Hao,GAO Yubei,FU Ziyi

• 1:上海市奉贤区中心医院麻醉科
• 2:南京市妇幼保健院

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:

Keywords:

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

DOI: 10.19367/j.cnki.1000-2707.2019.01.016

参考文献(References)：

• [1]史建稳,王敦亮,张鹏.右美托咪定或舒芬太尼复合丙泊酚用于无痛人工流产术的临床观察[J].世界最新医学信息文摘,2015,15(77):85-86.
• [2]李绍臣,武知荣,周婷婷,等.关于丙泊酚配伍芬太尼静脉麻醉用于无痛人流的临床分析[J].中外女性健康研究,2018(12):37-38.
• [3]汪海洋,辜敏.右美托咪啶复合小剂量氯胺酮在无痛人流中的麻醉效果评价[J].西南国防医药,2016,26(12):1460-1462.
• [4]周勤.芬太尼与丙泊酚联合治疗无痛人流的效果分析[J].中国医药指南,2018,16(9):128-129.
• [5]陈兆芸.右美托咪啶预处理对七氟烷和芬太尼静吸复合全身麻醉效能的影响[D].广州:南方医科大学,2011.
• [6]DEWHIRST E,FEDEL G,RAMAN V,et al.Pain management following myringotomy and tube placement:intranasal dexmedetomidine versus intranasal fentanyl[J].Int J Pediatr Otorhinolaryngol,2014,78(7):1090-1094.
• [7]NEGI S,SEN I,ARYA V,et al.Dexmedetomidine versus fentanyl as coadjuvants of balanced anaesthesia technique in renal transplant recipients[J].Middle East JAnaesthesiol,2014,22(6):549-557.
• [8]周建军,胡美.地佐辛和芬太尼用于无痛人工流产的效果及安全性比较研究[J].现代医药卫生,2014,30(14):2086-2088.
• [9]周蓓.右美托咪啶与丙泊酚用于门诊无痛人流术中麻醉效果的分析[J].实用妇科内分泌杂志(电子版),2016,3(19):50-51.
• [10]陈素青.丙泊酚静脉麻醉在无痛人工流产术中的应用观察[J].中外医学研究,2018,16(6):137-139.
• [11]YU C,LI S,DENG F,et al.Comparison of dexmedetomidine/fentanyl with midazolam/fentanyl combination for sedation and analgesia during tooth extraction[J].Int JOral Maxillofac Surg,2014,43(9):1148-1153.
• [12]SARKAR A,BAFILA N S,SINGH R B,et al.Comparison of epidural bupivacaine and dexmedetomidine with bupivacaine and fentanyl for postoperative pain relief in lower limb orthopedic surgery[J].Anesth Essays Res,2018,12(2):572-580.
• [13]李天佐.右美托咪啶在麻醉中的应用[J].北京医学,2010,32(08):587-590.
• [14]LERVIK A,RASZPLEWICZ J,RANHEIM B,et al.Corrigendum to'dexmedetomidine or fentanyl?cardiovascular stability and analgesia during propofolketamine total intravenous anaesthesia in experimental pigs[J].Vet Anaesth Analg,2018,45(5):717-718.
• [15]杨惠茹,辛学东,解雅英.右美托咪定减轻手术患者免疫抑制的研究进展[J].医学综述,2018,24(11):2250-2254.
• [16]雷家秀.丙泊酚联合芬太尼在无痛人流术中的麻醉效果分析[J].河南医学研究,2018,27(3):441-442.
• [17]农兰依,王高强,黄晓媚,等.丙泊酚复合芬太尼或舒芬太尼用于门诊无痛人流手术的效果对比分析[J].海峡药学,2018,30(3):95-97.
• [18]何翠英,何惠贤.丙泊酚联合芬太尼在无痛人流术中镇痛效果的研究[J].深圳中西医结合杂志,2018,28(5):105-106.
• [19]宁锋锋,姚婷婷,李静.右美托咪定对全麻子宫切除患者血流动力学及应激反应的影响[J].中国初级卫生保健,2017,31(06):78-79.
• [20]ELGEBALY A S,SABRY M.Sedation effects by dexmedetomidine versus propofol in decreasing duration of mechanical ventilation after open heart surgery.Ann Card Anaesth,2018,21(3):235-242.
• [21]王华.丙泊酚复合小剂量芬太尼在无痛人流麻醉应用中的效果和安全性分析[J].临床合理用药杂志,2018,11(5):63-64.
• [22]陈思佳.右美托咪定与芬太尼对无痛人流的临床安全性及效果观察[J].中国医药指南,2018,16(7):6-7.
• [23]SARKAR A,BAFILA N S,SINGH R B,et al.Comparison of Epidural Bupivacaine and Dexmedetomidine with Bupivacaine and Fentanyl for Postoperative Pain Relief in Lower Limb Orthopedic Surgery[J].Anesth Essays Res,2018,12(2):572-580.

文章评论(Comment)：