Abstract:

Objective　To study the application effect and adverse reactions of dexmedetomidine in daytime hysteroscopic anesthesia. Methods　A total of 360 hysteroscopic anesthesia patients in Xiamen First Hospital Affiliated to Xiamen University from October 2019 to October 2020 were divided into two groups with the random number table method with 180 cases in each group. In the control group, the age was (34.74±5.12) years old, and the body weight was (57.52±6.58) kg; in the study group, the age was (35.32±4.51) years old, and the body weight was (56.02±7.01) kg. The control group was given propofol combined with sevoflurane, and the study group was given dexmedetomidine combined with sevoflurane. The vital signs before induction of anesthesia (T0), during induction (T1), during operation (T2), and while awake (T3), awakening, recovery score after anesthesia, adverse reactions, Ramsay sedation score, Observer's Assessment of Alertness/Sedation Scale (OAA/S) score, and Numerical Rating Scale (NRS) score were observed. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　There were no statistically significant differences in the operation time, incidences of hypertension, tachycardia, and bradycardia, and heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SpO₂) at T0 between the two groups (all P>0.05). There were statistically significant differences in the HR, MAP, and SpO₂ between T1, T2, and T3 and T0 in the two groups (all P<0.05), and the HR and MAP decreased to a certain extent in the two groups. The awakening time and leaving time of the study group were shorter than those of the control group, and the incidence of respiratory depression was lower than that of the control group [0 vs. 3.89% (7/180)], with statistically significant differences (all P<0.05). The Alderete scores of the study group 10, 20, and 30 min after operation were higher than those of the control group, with statistically significant differences (all P<0.05). The incidences of postoperative pain [6.67 (3/180) vs. 38.33% (18/180)] and nightmare recall [0 vs. 16.67% (8/180)] in the study group were lower than those in the control group, with statistically significant differences (both P<0.05). After operation, the Ramsay score and OAA/S wakefulness score of the study group were higher than those of the control group, with statistically significant differences (both P<0.05). After operation, the NRS score of the study group was lower than that of the control group [(1.03±0.27) vs. (2.46±0.34)], with a statistically significant difference (t=44.189, P<0.001). Conclusion　Dexmedetomidine can be used for daytime hysteroscopy, which has good anesthetic effect, high safety, and less impact on patients' vital signs, so it is worthy of application.

Key words: Dexmedetomidine, Daytime hysteroscopy, Anesthesia, Effect, Adverse reactions

摘要： 目的　研究右美托咪啶在日间宫腔镜麻醉中的应用效果及不良反应。方法　选择厦门大学附属厦门第一医院2019年10月至2020年10月期间收入的宫腔镜麻醉患者360例，按照随机数字表法分为两组，每组180例。对照组患者年龄（34.74±5.12）岁，体质量（57.52±6.58）kg；研究组患者年龄（35.32±4.51）岁，体质量（56.02±7.01）kg。对照组使用丙泊酚复合七氟烷，研究组使用右美托咪啶复合七氟烷。观察两组患者麻醉诱导前（T0）、诱导时（T1）、手术中（T2）、清醒时（T3）的生命体征、苏醒情况、麻醉后恢复评分以及不良反应、Ramsay镇静评分、警觉/镇静（OAA/S）评分、疼痛数字评分量表（NRS）评分。统计学方法采用独立样本t检验、配对t检验、χ²检验。结果　两组患者的手术时间、高血压、心动过速、心动过缓发生率、T0时的心率（HR）、平均动脉压（MAP）以及血氧饱和度（SpO₂）比较差异均无统计学意义（均P>0.05）；两组患者的HR、MAP、SpO₂在T1、T2、T3时与T0时比较差异均有统计学意义（均P<0.05），组内HR、MAP均出现一定程度下降；研究组患者的苏醒时间、离室时间均短于对照组，呼吸抑制发生率低于对照组［0比3.89%（7/180）］，差异均有统计学意义（均P<0.05）；研究组术后10、20、30 min的麻醉恢复评分均高于对照组，差异均有统计学意义（均P<0.05）；研究组患者术后疼痛发生率［6.67（3/180）比38.33%（18/180）］和噩梦回忆发生率［0比16.67%（8/180）］均较对照组低，差异均有统计学意义（均P<0.05）。术后，研究组的Ramsay镇静评分及OAA/S评分均高于对照组，差异均有统计学意义（均P<0.05）；术后，研究组的NRS评分低于对照组［（1.03±0.27）分比（2.46±0.34）分］，差异有统计学意义（t=44.189，P<0.001）。结论　对于日间宫腔镜手术可使用右美托咪啶，能够起到良好的麻醉效果，安全性较高，对患者生命体征影响较小，值得推广。

关键词: 右美托咪啶, 日间宫腔镜手术, 麻醉, 效果, 不良反应