右美托咪定在宫颈癌手术中的应用以及对VAS评分的影响

doi:10.3760/cma.j.issn.1007-1245.2022.23.023

摘要/Abstract

摘要： 目的　探析右美托咪定在宫颈癌手术中的应用效果及对患者视觉模拟疼痛评分（VAS）的影响。方法　选取南阳医学高等专科学校第一附属医院2021年5月至2022年5月于南阳医学高等专科学校第一附属医院择期行手术治疗的130例宫颈癌患者为研究对象，采用抽签法将患者分为试验组和对照组，各65例。试验组年龄（45.36±1.17）岁，病程（6.65±0.33）个月。对照组年龄（45.11±1.46）岁，病程（6.58±0.24）个月。两组术中均予以常规麻醉诱导及维持麻醉，试验组术中应用右美托咪定辅助麻醉。比较两组不同时间视觉模拟疼痛评分（VAS）评分、术中血流动力学、术后应激反应及苏醒后不良事件发生情况。采用t检验和χ²检验。结果　试验组给药前（T0）VAS评分（2.52±0.11）分，对照组（2.55±0.42）分，差异无统计学意义（t=0.557，P=0.578）；试验组给药后即刻（T1）、给药后10 min（T2）、给药后30 min（T3）、术毕（T4）VAS评分均低于对照组［（2.05±0.17）分比（2.31±0.22）分，t=7.540，P<0.001；（1.82±0.33）分比（2.17±0.45）分，t=5.057，P<0.001；（1.55±0.35）分比（1.92±0.46）分，t=5.161，P<0.001；（1.62±0.47）分比（1.98±0.72）分，t=3.376，P<0.001］。试验组术中血氧饱和度（SPO₂）略低于对照组［（98.44±0.27）%比（98.62±0.74）%，t=1.842，P=0.068］，动脉氧分压（PaO₂）略低于对照组［（95.15±0.41）mmHg（1 mmHg=0.133 kPa）比（95.34±0.72）mmHg，t=1.849，P=0.065）］，动脉二氧化碳分压（PaCO₂）略高于对照组［（35.22±1.45）mmHg比（35.04±1.62）mmHg，t=0.668，P=0.506］，平均动脉压（MAP）略高于对照组［（84.41±2.23）mmHg比（84.15±2.12）mmHg，t=0.681，P=0.497］。试验组术后过氧化氢（CAT）高于对照组［（7.32±0.26）U/ml比（6.55±0.17）U/ml，t=19.984，P<0.001］，谷胱甘肽过氧化物酶（GSH-Px）高于对照组［（135.37±10.88）U/ml比（132.62±10.41）U/ml，t=1.472，P<0.001］，丙二醛（MDA）低于对照组［（5.25±0.24）nmol/ml比（6.44±0.62）nmol/ml，t=14.431，P<0.001］，皮质醇（Cor）低于对照组［（40.35±2.17）ng/ml比（43.37±2.26）ng/ml，t=7.771，P<0.001）］，术后不良事件发生率略高于对照组［10.77%（7/65）比7.69%（5/65），χ²=0.566，P=0.452］。结论　在宫颈癌患者术中应用右美托咪定辅助麻醉可增强其镇痛效果，此药可在保证患者术中血流动力学稳定的同时降低术后应激及苏醒后不良事件发生风险，值得推广。

关键词: 宫颈癌手术, 右美托咪定, 疼痛视觉模拟评分, 血流动力学, 不良事件

Abstract: Objective　To observe and analyze the effect of dexmedetomidine in cervical cancer surgery and its influence on patients' score of Visual Analogue Scale (VAS). Methods　One hundred and thirty patients with cervical cancer surgically treated at First Hospital, Nanyang Medical College from May 2021 to May 2022 were selected as the research objects, and were divided into an experimental group and a control group by lottery, with 65 cases in each group. The experimental group were (45.36±1.17) years old, with a disease course of (6.65±0.33) months. The control group were (45.11±1.46) years old, with a disease course of (6.58±0.24) months. Both groups were given routine anesthesia induction and maintenance anesthesia during operation. Dexmedetomidine was used as auxiliary anesthesia during operation in the experimental group. The VAS scores, intraoperative hemodynamics, postoperative stress reaction, and adverse events after awakening were compared between the two groups at different times. t and χ² test were applied. Results　The VAS score of the experimental group before administration (T0) was not statistically different from that of the control group [(2.52±0.11) vs. (2.55±0.42), t=0.557, P=0.578). The VAS scores immediately (T1), 10 min (T2), and 30 min (T3) after administration, and after the operation (T4) in the experimental group were lower than those in the control group [(2.05±0.17) vs. (2.31±0.22), t=7.540, P<0.001; (1.82±0.33) vs. (2.17±0.45), t=5.057, P<0.001; (1.55±0.35) vs. (1.92±0.46), t=5.161, P <0.001; (1.62±0.47) vs. (1.98±0.72), t=3.376, P<0.001]. The oxygen saturation of blood (SpO₂), arterial oxygen partial pressure (PaO₂), arterial blood carbon dioxide partial pressure (PaCO₂), and mean arterial pressure (MAP) were (98.44±0.27)%, (95.15±0.41) mmHg, (35.22±1.45) mmHg, and (84.41±2.23) mmHg in the experimental group, and were (98.62±0.74)%, (95.34±0.72) mmHg, (35.04±1.62) mmHg, and (84.15±2.12) mmHg in the control group (t=1.842, P=0.068, t=1.849, P=0.065; t=0.668, P=0.506; and t=0.681, P=0.497). After the operation, the levels of hydrogen peroxide (CAT), glutathione peroxidase (GSH-Px), malonaldehyde (MDA), and cortisol (Cor) and the incidence of postoperative adverse events were (7.32±0.26) U/ml, (135.37±10.88) U/ml, (5.25±0.24) nmol/ml, (40.35±2.17) ng/ml, and 10.77% (7/65) in the experimental group, and were (6.55±0.17) U/ml, (132.62±10.41) U/ml, (6.44±0.62) nmol/ml, (43.37±2.26) ng/ml, and 7.69% (5/65) in the control group (t=19.984, P<0.001; t=1.472, P<0.001; t=14.431, P<0.001; t=7.771, P<0.001; χ²=0.566, P=0.452). Conclusions　Dexmedetomidine assisted anesthesia can enhance the analgesic effect of cervical cancer patients during operation. This drug can ensure the stability of hemodynamics during operation and reduce the risk of postoperative stress and adverse events after awakening.

Key words: Cervical cancer surgery, Dexmedetomidine, Visual Analogue Scale, Hemodynamics, Adverse events

张冉徐国亭. 右美托咪定在宫颈癌手术中的应用以及对VAS评分的影响[J]. 国际医药卫生导报, 2022, 28(23): 3350-.

Zhang Ran, Xu Guoting. Application of dexmedetomidine in cervical cancer surgery and its effect on VAS score [J]. International Medicine and Health Guidance News, 2022, 28(23): 3350-.

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