右美托咪定对妇科腹腔镜手术患者术后恶心呕吐和镇痛的影响  

Effects of dexmedetomidine on postoperative nausea,vomiting and analgesia in patients undergoing gynecological laparoscopic surgery

作　　者：刘珏莹[1] 陈智[2] 仓静[2] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200127 [2]复旦大学附属中山医院麻醉科

出　　处：《上海医学》2014年第12期995-999,共5页Shanghai Medical Journal

摘　　要：目的探讨不同剂量右美托咪定(DEX)能否预防或减少妇科腹腔镜手术患者术后恶心呕吐(PONV)的发生及其对术后镇痛的影响。方法选择美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级择期在全身麻醉下行妇科腹腔镜手术的患者60例,随机分入氯化钠溶液组(NaCl组)、DEX 0.4μg/kg组(DEX 0.4组)和DEX0.2μg/kg组(DEX 0.2组),每组20例。试验药物均使用0.9%氯化钠溶液稀释至10mL,麻醉诱导前3组患者分别经微量静脉输液泵恒速输注0.9%氯化钠溶液、DEX 0.4μg/kg、DEX 0.2μg/kg各10mL,输注时间为10min。比较3组患者的一般情况、手术时间、睁眼时间、自主呼吸恢复时间和拔除气管导管时间,以及术后0.5h(T1)时的Ramsay镇静评分。采用疼痛视觉模拟评分(VAS评分)评估患者术后1h(T2)、12h(T3)、24h(T4)各时间点的镇痛效果。记录患者T1至T4时间点的PONV发生情况及其严重程度。记录患者苏醒24h内其他不良反应发生情况和术后24h内患者自控镇痛(PCA)有效按压次数,以及术中和术后阿片类药物使用量。结果 DEX 0.4组在T1、T2、T3、T4时间点的PONV发生率均显著低于NaCl组同时间点(P值均<0.05),DEX 0.2组在T4时间点的PONV发生率显著低于NaCl组同时间点(P<0.05)。DEX 0.4组和DEX0.2组在T2时间点的PONVⅡ级构成比均显著少于NaCl组同时间点(P值均<0.05)。术后24h内,DEX0.4组和DEX 0.2组的心动过缓发生率均显著高于NaCl组(P值均<0.05),术后严重疼痛发生率和平均PCA按压次数均显著少于NaCl组(P值均<0.05),平均PCA按压次数和术后芬太尼使用量均显著少于NaCl组(P值均<0.05)。结论小剂量DEX能明显降低妇科腹腔镜手术PONV的发生率,加强阿片类药物的镇痛效果,且0.4mg/kg剂量的DEX效果更为显著,但应注意心动过缓、镇静过度等不良反应的发生。Objective To investigate whether dexmedetomidine hydrochloride can prevent or reduce the incidence of postoperative nausea and vomiting （PONV） and the effect of dexmedetomidine on postoperative analgesia in patients undergoing gynecological laparoscopic surgery. Methods Sixty patients （American Society of Anesthesiologists grade Ⅰ to Ⅱ ） scheduled for gynecological laparoscopic surgery under general anesthesia were randomly assigned to 3 groups （n = 20） ： high dose dexmedetomidine group, low dose dexmedetomidine group and control group. Experimental drugs （0.4 wg/kg dexmedetomidine in high dose dexmedetomidine group, 0.2 wg/kg dexmedetomidine in low dose dexmedetomidine group and normal saline in control group） were diluted with normal saline to 10 mL and infused 10 min before induction. Operation time, eyes open time, spontaneous breathing recovery time, extubation time and Ramsay sedation score at 30 minutes after surgery （T1） were compared between groups. Visual analog scale （VAS） scores at 1 h （T2）, 12 h （T3）, and 24 h （T4） after surgery were recorded. The incidence of PONV, patient-controlled analgesia （PCA） pressing times, PCA related adverse events and perioperative opioid drug consumption were also recorded. Results The incidences of PONV in the high dose dexmedetomidine group at the time points of T1, T2, T3and T, were significantly lower than those in the control group （all P〈0.05）. The incidence of PONV in the low dose dexmedetomidine group at T4 was significantly lower than that in the control group （P〈0.05）. The incidences of PONV grade Ⅱ in both dexmedetomidine groups were significantly lower than those in the control group at T2 （both P〈0.05）. The incidence of bradycardia in both dexmedetomidine groups were significantly higher than those in the control group within 24 h after surgery （all P〈 0.05）. Compared with those in the control group, postoperative analgesic demand, PCA times and postoperative fentanyl consumption were si

关 键 词：右美托咪定 术后恶心呕吐 镇静 镇痛 妇科腹腔镜手术 

分 类 号：R614[医药卫生—麻醉学]