ABSTRACT
Objective To explore the impact of different doses of dexmedetomidine on the anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy.Methods 90 patients with uterine fibroids with ASA class Ⅰ or Ⅱ who were going to undergoing general intravenous anesthesia laparoscopic hysterectomy were selected and they were divided into group A (dexmedetomidine 0.4μg·kg-1·h-1,n=30) and group B (dexmedetomidine 0.2μg·kg-1·h-1,n=30) and group C (no dexmedetomidine,n=30) by digital random method.The analgesia effect (VAS score) of group A,group B and group C preoperation and postoperative 1h,12h and 24h,and the sedation (Ramsay sedation score) were compared.General information,postoperative blood pressure,heart rate,pulse oxygen saturation,postoperative patients'' satisfaction on analgesic effect and the sedation effect and adverse reactions of the three groups were also compared.Results Age,body mass index and other basic information of three groups had no statistically significant differences (all P＞0.05).The preoperative VAS score of the three groups also had no statistically significant difference (F=0.625,P＞0.05).Postoperative 12h,24h,the VAS scores of group A and group B were lower than those of C group,which of group A were lower than group B (F=11.250,P＜0.05,F=21.181,P＜0.05).The Ramsay sedation score was higher than that of C group[(3.67±0.18) vs.(2.13±0.11)].The satisfaction of group A was significantly higher than group B and group C (96.67％ vs.73.33％,46.67％,χ2=25.953).The Ramsay sedation score and satisfaction were higher than those of group B (all P＜0.05).There were no significant differences in blood pressure (F=0.362,P＞0.05),pulse oxygen saturation (F=0.978,P＞0.05) and heart rate among the three groups before and after operation (F=1.268,P＞0.05).There was no obvious adverse reaction in the three groups.Conclusion Dexmedetomidine can promote anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy,and the dose 0.4μg·kg-1·h-1 of dexmedetomidine has better effect,feasibility and safety,it is worthy of clinical promotion.
ABSTRACT
Objective To discuss the influence on cerebral oxygen balance and metabolism of propofol target controlled infusion induced tracheal intubation in patients with laparoscopic surgery.Methods A total of 96 patients with gynecologic laparoscopic surgery were selected from January 2012 to October 2013.All patients were in propofol target controlled infusion anesthesia induction downward internal jugular vein retrograde through jugular vein ball tube,radial artery catheter.According to propofol target controlled infusion target concentrations,96 patients were divided into A group (32 cases,3 μ g/ml),B group (33 cases,5 μμg/ml) and C group (31 cases,7 μg/ml).Hemodynamic and Nacotrend index (NI) change were monitored in the process of surgery patients,with internal jugular vein and radial artery blood at pre-induction (To),intubation (T1),30 min after intubation (T2) and the end of the operation (T3) were detected and arterial blood oxygen saturation (PaO2),arterial oxygen content (CaO2),internal jugular vein ball blood oxygen saturation (SjvO2),internal jugular vein ball blood oxygen partial pressure (PjvO2) at different time points were compared among three groups.Artery-internal jugular vein ball low blood oxygen of components (Da-jvO2),brain oxygen uptake rate (CEO2),poor lactic acid content (Da-jvL) were calculated.Results The systolic blood pressure,heart rate and NI at T1,T2 was lower than that at To in three groups,and there was significant difference (P ＜ 0.05),but there was significant difference in NI at T1,T2 among three groups (P ＜ 0.05).Compared with T0,PaO2,PjvO2,SjvO2 and CaO2 at T1-T3 in three groups were increased significantly (P ＜ 0.05),and the highest was C group,and then B group and A group.In the process of propofol target controlled infusion,Da-jvO2,CEO2 and Da-jvL showed a trend of gradual decline,Da-jvL decline highest significantly (P ＜ 0.05).Conclusions Propofol target controlled infusion induced endotracheal intubation can decrease the laparoscopic surgery in patients with cerebral oxygen metabolism and the brain tissue of ischemia hypoxia tolerance,but will not lead to cerebral oxygen supply and demand imbalance,and 7 μ g/ml concentration of propofol anesthesia effect is the best.