Clinical Observation Of Dexmedetomidine Intranasal Drops In Outpatient Patients With Painless Abortion

Objective:Abortion is common remedies for pregnancy women of childbearing age,is a common clinical simpler operation,according to the epidemiological investigation,because the patients for pain,privacy,and postoperative recovery,affect the normal work and life concerns,before the preoperative abortion can produce different levels of anxiety,fear,depression and other psychological state.Serious patients can appear strong stress and negative emotions,activation of the hypothalamus-pituitary-adrenal cortex axis,and secrete a large number of stress hormones,to make the body produce a series of changes,intraoperative can appear artificial abortion syndrome,and affect the occurrence of postoperative endocrine disorders and mood disorders,etc.For the safety of the surgery and postoperative rehabilitation bring bad effects.Dexmedetomidine hydrochloride is a novel and highly selectiveα₂ adrenergic receptor agonist,which has sedative,analgesic,antianxiety,inhibitory sympathetic activity and stress response effects,and has stable hemodynamics.Adults have a nasal mucosa with an area of about 150cm²,which is similar in structure to small intestinal villi,with abundant capillaries and lymphatic vessels,and there is communication between the nasal mucosa and cerebrospinal fluid.Therefore,the effect of intranasal administration can achieve or even exceed the effect of intravenous administration.Nasal dexmedetomidine can assist in a variety of clinical invasive tests,but whether dexmedetomidine nasal drops have a positive clinical effect on women undergoing induced abortion is unclear.The aim of this study was to observe the effects of intranasal infusion of dexmedetomidine hydrochloride on preoperative anxiety,stress response and intraoperative anesthesia in patients undergoing painless abortion.Methods:Sixty patients（aged 20-45 years old,ASA grade I-II）who planned to undergo painless induced abortion in the outpatient department were selected.They were randomly divided into two groups:dexmedetomidine group（dexmedetomidine group）and control group with30 patients in each group（n=30）.Dexmedetomidine 1μg/kg（100μg/m L）or normal saline 0.5 m L were intranasally aspiration 1h before surgery,respectively.Respectively before the dosing and 30 min after the treatment with the same anxious state questionnaire（SAI）rate,draw blood samples to determine serum Norepinephrine and Cortisol concentration,and record the intranasal before（T1）,5 min after intranasal（T2）,30 min after intranasal（T3）,before anesthesia induction（T4）and eyelash reflex disappears（T5）,expanding cervix（T6）,and at the end of surgery（T7 has）in patients with blood oxygen saturation,heart rate,mean arterial pressure value,records of anesthesia induction time（propofol began pumping to eyelash reflex disappearing）.Time of recovery（stop the infusion of propofol until Steward score≥5）,dosage of propofol and additional cases.Results:Before nasal drip（t1）,there were no significant differences in anxiety state score,serum cortisol and norepinephrine concentrations between the two groups.Compared with the control group,anxiety state score and serum cortisol and norepinephrine concentrations in Dexmex group were decreased before anesthesia induction（t2）,with statistical significance（P<0.05）.All patients were conscious and in normal mental state before anesthesia induction.Compared with the control group,the dosage of propofol in dexmedetomidine group decreased,and the time of anesthesia induction was shortened significantly（P<0.05）.There was no significant difference in operation time and anesthesia recovery time between the two groups.Compared with before nasal drip（T1）,heart rate and mean arterial pressure in Youmei group decreased at T3-T7,while SpO₂ increased at T5 and T6,while heart rate and mean arterial pressure in Youmei group decreased at T5 and T6,and SpO₂ increased,with statistical significance（P<0.05）.Compared with the control group,the mean arterial pressure in Youmei group decreased at T2-T7,and the difference was statistically significant（P<0.05）.There were no statistically significant differences in heart rate and SpO₂ among groups at each observation time point.Conclusions:Dexmedetomidine nasal drops combined with intravenous propofol anesthesia for painless abortion can relieve anxiety,reduce stress level and general anesthetic dose.After dexmedetomidine nasal drip,the whole observation period in patients with mean arterial pressure were lower than the control group,this may be the dexmedetomidine to remove the sympathetic tension,relieve tension caused by waiting for a reason,but it may also indicate that when combined with propofol,there may be synergism in circulatory inhibition,that on the one hand,it is recommended that patients given propofol anesthesia should be monitored for vital signs.On the other hand,it is suggested that it is necessary to perform appropriate fluid rehydration and volume enlargement before surgery to prevent circulation inhibition.