Clinical Efficacy Evaluation Of Patients Undergoing Gynecological Laparoscopic Surgery With Dexmedetomidine Hydrochloride At Different Time Points

Objective:Dexmedetomidine has been widely used in clinical practice,and its application in gynecological laparoscopic surgery has been widely reported.However,there are few comparative studies on the efficacy of dexmedetomidine at different time points.This study explore the dexmedetomidine hydrochloride?DEX?different time node to drug therapy for patients with gynecological laparoscopic surgery,for the treatment of the postoperative analgesia,sedation,and nausea and vomiting curative effect is analyzed,so as to find out the best efficacy and safety of the dosing point in time,for reference and guidance for the clinical anesthesia and research basis.Methods:Selection of affiliated hospital of yan'an university in December 2017 to December2018 gynecological laparoscopic elective surgery of 90 case of patient.ASA class I-II,aged 20-60 years old,with BMI<28kg/m² and anesthesia time<3h.The patients were randomly divided into three groups:preoperative group?intravenous infusion of dexmedetomidine?0.5ug/kg?within 10min before anesthesia induction,??n=30?,intraoperative group?expected intravenous infusion of dexmedetomidine?0.5ug/kg?within 10min,it is expectd to be 40 minutes before the end of surgery??n=30?,and postoperative group?0.5ug/kg dexmedetomidine was added into analgesic pump??n=30?.PCIA pump configuration:sufentanil 1ug/kg,tropisetron 10mg,flurbiprofen100mg,add normal saline to 100ml capacity.Continuous dose 2ml/h,locking time 15minutes,automatic control dose 2ml each time,load 2ml.Record anesthesia time,postoperative spontaneous breathing recovery time,and extubation time were recorded,and the postoperative 0.5h,2h,12h,24h,Ramsay sedation score,VAS analgesia score,postoperative nausea and vomiting score and adverse reactions.After the Patients enters the operating room and connect ecg monitor and PET-CO₂monitor,open venous pathway for preoperative medicine 2mg midazolam,anesthesia induction for all by intravenous anesthesia,anesthesia induction after intubation anesthesia machine line of mechanical ventilation,VT is 8-10 ml/kg,f 10-14 times/min,I:E is 1:2,the oxygen flow rate of 1-2l/min,exhale through intraoperative breathing parameters will be at the end of the co2partial pressure at 35 to 45 mmHg.Maintain static absorption composite maintain anesthesia,intraoperative continuous static push cisatracurium besylate to maintain a good muscle relaxant,pneumoperitoneum pressure setting of 13-15 mmHg,intraoperative by adjusting the concentration of sevoflurane inhalation,propofol and remifentanil pump injection speed stable cycle,after the above processing 3 min still SBP>160 mm Hg or DBP>100 mm Hg,nicardipine to 0.2 mg/time,SBP<80 mmHg infusion speed and static note when dopamine 1 mg/time,At HR<50 times/min,intravenous injection of atropine 0.5mg/time,HR>100 times/min,intravenous injection of esmolol 10mg/time,repeated if necessary.Muscle relaxants were expected to be discontinued 30min before the end of the operation,sevoflurane and propofol were discontinued after pneumoperitoneum,and remifentanil was discontinued after the operation and the postoperative analgesic pump was connected intravenously.Results:1.There was no significant difference in age,BMI,anesthesia time,spontaneous breathing recovery time and extubation time comparison between the three groups?P>0.05?.2.The VAS scores at each postoperative time point were compared among the three groups.Compared with postoperative group,the VAS scores of preoperative group at the two time points of 0.5h and 2h were statistically significant?P<0.05?.Compared with postoperative group,the VAS scores of intraoperative group at the two time points of 0.5h and 2h were statistically significant?P<0.05?.3.Ramsay scores in each postoperative time point were compared among the three groups,Compared with the postoperative group,the Ramsay scores of 0.5h was increased in the preoperative group?P<0.05?,and Ramsay scores were decreased at 2h,12h,24h Compared with the postoperative group,the Ramsay scores of 0.5h was increased in the intraoperative,and Ramsay scores were decreased at 12h and 24h?P<0.05?.Compared with the intraoperative group,the Ramsay score of 0.5h,2h and 12h were decreased in the preoperative group?P<0.05?.4.Comparison of postoperative nausea scores among the three groups showed that the incidence of nausea in the preoperative group was significantly lower than that in the postoperative group at 0-0.5h,0.5h-2h,2-12h and 12-24h hours after surgery,and the difference was statistically significant?P<0.05?.The incidence of nausea during 0-0.5h was lower in the intraoperative group than in the postoperative group,and the difference was statistically significant?P<0.05?.The incidence of nausea in the preoperative group was significantly lower than that in the intraoperative group in the three time periods of0.5h-2h,2-12h and 12-24 after surgery,and the difference was statistically significant?P<0.05?.5.comparison of the incidence of postoperative vomiting in the three groups at 24h after surgery showed that the incidence of mild and moderate vomiting in the intraoperative group was lower than that in the postoperative group?P<0.05?,and the incidence of moderate vomiting in the intraoperative group was lower than that in the postoperative group?P<0.05?.Compared with the intraoperative group,the rate of mild vomiting in the preoperative group decreased after surgery?P<0.05?.6.The incidence of postoperative complications was compared among the three groups,Compared with the postoperative group,the incidence of nausea and vomiting in the preoperative group was reduced,and the difference was statistically significantP<0.05).Conclusion:Clinical observation of dexmedetomidine at different time points intravenous in patients undergoing gynecological laparoscopic surgery:The drugs were administered before anesthesia induction and before the end of surgery,both of them can improve the postoperative comfort and satisfaction of patients.In general,intravenous infusion of dexmedetomidine hydrochloride?0.5ug/kg?10min before anesthesia induction,which can more effectively prevent postoperative nausea and vomiting of patients undergoing gynecological laparoscopic surgery and have good sedative and analgesic effects,with a lower incidence of postoperative adverse reactions.