右美托咪定对妇科腹腔镜手术患者血浆胃动素及术后不良反应的影响  

Effects of dexmedetomidine on plasma motilin and postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery

作　　者：徐保芹 王洁 张超[1] 韩兰 吴丽丽 姚明[1] 曹晖[1] XU Bao-qin;WANG Jie;ZHANG Chao;HAN Lan;WU Li-li;YAO Ming;CAO Hui(Department of Anesthesiology,Wujiang Hospital Affiliated to Nantong University,Soochow 215200,Jiangsu,China)

机构地区：[1]南通大学附属吴江医院麻醉科,苏州医学硕士研究生215200

出　　处：《医学研究生学报》2019年第5期526-531,共6页Journal of Medical Postgraduates

摘　　要：目的腹腔镜手术患者避免术后恶心呕吐的发生可以加快术后康复。文中旨在观察盐酸右美托咪定(DEX对妇科腹腔镜手术患者血浆胃动素及术后恶心呕吐的影响。方法选取2017年6月至2018年6月南通大学附属吴江医院麻醉科80例择期全麻下行妇科腹腔镜下手术的患者。根据静脉自控镇痛(PCIA)药物种类将患者随机分为:右美托咪定组(术毕40 min前泵注DEX 0.5μg/kg,术后PCIA予DEX 2.5μg/kg+舒芬太尼2.5μg/kg)、对照组(仅术毕前40 min静脉泵注等量的等渗盐水10 min,术后PCIA为舒芬太尼2.5μg/kg),每组40例。分析比较2组拔管前后的呛咳评分、镇静-躁动评分(SAS)评分及术前、术后2 h、24 h、48 h血浆胃动素的浓度、术后恶心呕吐的发生率及严重程度等情况。结果右美托咪定组拔管前后呛咳评分及SAS评分较对照组明显降低(P<0.05)。右美托咪定组术后2 h、24 h血浆胃动素浓度[(391.39±54.49)、(321.96±36.50)pg/mL]较对照组[(478.81±42.94)、(385.64±38.03)pg/mL]显著降低(P<0.05)。右美托咪定组术后2 h、24 h中重度术后恶心呕吐的发生率(5.0%、2.5%)较对照组(25.0%、20.0%)明显降低(P<0.05)。右美托咪定组术后寒颤、烦躁发生率明显小于对照组,但术后口干及心动过缓发生率明显高于对照组(P<0.05)。结论妇科腹腔镜术毕前泵注0.5μg/kg DEX,PCIA小剂量维持,可减少术后血浆胃动素的释放,有效降低术后恶心呕吐的发生及严重程度,有助于患者早期恢复。Objective Increased pneumoperitoneum and intra-abdominal pressure during laparoscopic surgery may cause postoperative nausea and vomiting(PONV),avoiding the occurrence of which can accelerate postoperative recovery of the patients. In this study,we observed the effects of dexmedetomidine(DEX)on plasma motilin(MTL)and PONV in patients undergoing gynecologic laparoscopic surgery. Methods Eighty female patients underwent gynecological laparoscopic surgery under elective general anesthesia in our hospital from June 2017 to June 2018. We randomly assigned the patients to a control and a DEX group of equal number,the former injected intravenously with isotonic saline for 10 minutes at 40 minutes before the completion of surgery and the latter with DEX 0.5 μg/kg at 40 minutes before the end of and DEX 2.5 μg/kg + sufentanil 2.5 μg/kg after surgery. We compared the cough and sedation agitation scores(SAS)of the patients before and after extubation,the MTL concentration before and at 2,24 and 48 hours after surgery,and the incidence and severity of PONV at 2, 24 and 48 hours postoperatively between the two groups. Results Compared with the controls,the patients of the DEX group showed significantly decreased cough and SAS scores before and after extubation (P < 0.05),MTL concentration at 2 hours ([478.81 ± 42.94]vs[391.39 ± 54.49]pg/mL,P < 0.05)and 24 hours after surgery([385.64 ± 38.03]vs[321.96 ± 36.50]pg/ mL,P < 0.05),and incidence rate of severe PONV at 2 hours(25.0% vs 5.0%,P < 0.05)and 24 hours postoperatively(20.0% vs 2.5%,P < 0.05). Intravenous pump injection of DEX at 0.5 μg/kg before the end of surgery can inhibit the postoperative release of MTL,effectively reduce the incidence and severity of PONV,and contribute to early recovery of the patients undergoing gynecologic laparoscopic surgery. Conclusion In gynecological laparoscopic surgery,0.5 μg/kg DEX used before the end of the surgery and low-dose maintenance of PCIA can inhibit the release of MTL after operation,effectively reduce the incidence and

关 键 词：右美托咪定 术后恶心呕吐 不良反应 腹腔镜手术 血浆胃动素 舒芬太尼 

分 类 号：R713[医药卫生—妇产科学]