右美托咪定用于妇科腹腔镜术后镇痛预防恶心呕吐的适宜剂量  

Optimal dose of dexmedetomidine to prevent nausea and vomiting when used for postoperative analgesia after gynecological laparoscopic surgery

作　　者：刘振菁 陈易[2] 邢学宁 邱玉雪[2] 马松梅[1] 孙贺[1] 刘白沙 孔莉[1] Liu Zhenjing;Chen Yi;Xing Xuening;Qiu Yuxue;Ma Songmei;Sun He;Liu Baisha;Kong Li(Department of Anesthesiology,The First People′s Hospital of Shangqiu,Shangqiu 476000,China;Department of Anesthesiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Critical Care Medicine,Second Affiliated Hospital of Ningxia Medical University,Yinchuan 750001,China)

机构地区：[1]商丘市第一人民医院麻醉科,476000 [2]宁夏医科大学总医院麻醉科,银川750004 [3]宁夏医科大学第二附属医院重症医学科,银川750001

出　　处：《中华麻醉学杂志》2019年第9期1095-1098,共4页Chinese Journal of Anesthesiology

摘　　要：目的明确右美托咪定用于妇科腹腔镜患者术后镇痛预防恶心呕吐的适宜剂量。方法择期行妇科腹腔镜手术患者135例,年龄18~60岁,体重52~80 kg,ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为3组(n=45):对照组(C组)、右美托咪定1μg/kg组(D1组)和右美托咪定2μg/kg组(D2组)。麻醉诱导结束后即刻静脉输注右美托咪定0.4μg·kg^-1·h^-1至术毕前30 min。术毕完全清醒,拔除气管导管入PACU,接PCIA泵,配方为:舒芬太尼1.2μg/kg、地佐辛20 mg,生理盐水稀释至100 ml,背景输注速率2 ml/h,PCIA剂量0.5 ml,锁定时间15 min。D1组和D2组分别于PCIA泵中混合右美托咪定1和2μg/kg。于PACU时段(P1)、回病房即刻至12 h(P2)、12~24 h(P3)、24~36 h(P4)和36~48 h(P5)时段记录患者恶心和呕吐的发生情况。于回病房12、24、36和48 h(T1-4)时记录患者Ramsay镇静评分。VAS评分>3分时嘱患者按压PCIA。术后48 h随访,记录患者满意度、PCIA按压情况以及皮肤瘙痒、呼吸抑制、心动过缓和头晕的发生情况。结果与C组比较,D1组和D2组P2时段恶心发生率降低,P2,3时段PCIA按压次数减少(P<0.05)。3组各时点Ramsay镇静评分、患者满意度及心动过缓的发生率差异无统计学意义(P>0.05)。3组均无皮肤瘙痒、呼吸抑制和头晕发生。结论右美托咪定用于妇科腹腔镜患者术后镇痛预防恶心呕吐的适宜剂量为1μg/kg。Objective To determine the optimal dose of dexmedetomidine required to prevent nausea and vomiting when used for postoperative analgesia after gynecological laparoscopic surgery.Methods A total of 135 patients,aged 18-60 yr,weighing 52-80 kg,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective gynecological laparoscopic surgery,were divided into 3 groups(n=45 each)using a random number table method:control group(group C),dexmedetomidine 1μg/kg group(group D1)and dexmedetomidine 2μg/kg group(group D2).Immediately after anesthesia induction,dexmedetomidine 0.4μg·kg^-1·h^-1 was injected intravenously until 30 min before the end of surgery in all the patients.When the patient was fully awake at the end of surgery,the tracheal tube was removed,and patients were sent to postanesthesia care unit and received patient-controlled intravenous analgesia(PCIA).The PCIA solution contained sufentanil 1.2μg/kg and dezocine 20 mg in 100 ml of 0.9%normal saline.The PCIA pump was set up with a 0.5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2 ml/h.Dexmedetomidine 1 and 2μg/kg were added to PCIA solution in group D1 and group D2,respectively.The occurrence of nausea and vomiting was recorded in postanesthesia care unit stay period(P1)and in 0-12 h(P2),12-24 h(P3),24-36 h(P4)and 36-48 h(P5)periods after patients returned to the ward.Ramsay sedation score was recorded at 12,24,36 and 48 h after patients returned to the ward.When visual analogue scale score>3,patients were told to press PCIA.Patients were followed up for 48 h after surgery,and patients′satisfaction,pressing times of PCIA and occurrence of pruritus,respiratory depression,bradycardia and dizziness were recorded.Results Compared with group C,the incidence of nausea was significantly decreased in P2 period,and the pressing times of PCIA were reduced in P2,3 period in D1 and D2 groups(P<0.05).There was no significant difference in Ramsay sedation score at each time point,patients′satisfaction and

关 键 词：右美托咪啶 手术后恶心呕吐 剂量效应关系 药物 镇痛 病人控制 疼痛 手术后 

分 类 号：R614[医药卫生—麻醉学]