右美托咪定联合阿扎司琼用于术后静脉镇痛对女性患者腰椎融合术PONV的影响  

Effects of combined use of dexmedetomidine and azasetron in postoperative analgesia on postoperative nausea and vomiting in female patients after lumbar fusion surgery

作　　者：程洁[1] 尹号 宋尧 储友群 常玲 李娟[1] Cheng Jie;Yin Hao;Song Yao;Chu Youqun;Chang Ling;Li Juan(Department of Anesthesiology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院麻醉科,合肥230001

出　　处：《国际麻醉学与复苏杂志》2022年第10期1045-1049,共5页International Journal of Anesthesiology and Resuscitation

基　　金：安徽省自然科学基金(1908085MH251)。

摘　　要：目的评价右美托咪定(dexmedetomidine,Dex)联合阿扎司琼用于术后静脉镇痛对女性患者后路腰椎融合术术后恶心呕吐(postoperative nausea and vomiting,PONV)的防治效果。方法择期后路多节段腰椎融合术的女性患者180例,年龄18~65岁,BMI 18~30 kg/m^(2),ASA分级Ⅰ、Ⅱ级。采用随机数字表法分为3组(每组60例):Dex+阿扎司琼组(DA组)、Dex组(D组)、阿扎司琼组(A组),术后静脉镇痛配方分别为Dex 1.5μg/kg+阿扎司琼30 mg+舒芬太尼2μg/kg、Dex 1.5μg/kg+舒芬太尼2μg/kg、阿扎司琼30 mg+舒芬太尼2μg/kg,均用生理盐水稀释到100 ml,输注速度为2 ml/h。缝皮时开始连接术后镇痛泵。比较3组患者术后0~6 h、6~12 h、12~24 h、24~48 h、0~48 h恶心、呕吐及补救止吐情况。记录3组患者术后6、12、24、48 h静息VAS疼痛评分、Ramsay镇静评分。观察3组患者术后48 h内补救镇痛及低血压、心动过缓、Ramsay镇静评分≥4分、头晕/头痛、腹胀/便秘、皮疹等不良反应发生情况。结果与A组比较:DA组术后0~6 h、6~12 h、24~48 h、0~48 h恶心发生率下降(P<0.05),术后6~12 h、0~48 h呕吐发生率下降(P<0.05),补救止吐例数明显减少(P<0.05);D组术后0~6 h恶心、呕吐发生率升高(P<0.05)。与D组比较:DA组术后0~6 h、6~12 h、0~48 h恶心发生率下降(P<0.05),术后0~6 h、6~12 h、0~48 h呕吐发生率下降(P<0.05),补救止吐例数也明显减少(P<0.05)。3组患者术后6、12、24、48 h静息VAS疼痛评分、Ramsay镇静评分及补救镇痛情况比较,差异无统计学意义(P>0.05)。3组患者术后48 h内低血压、心动过缓、Ramsay镇静评分≥4分、头晕/头痛、腹胀/便秘、皮疹等不良反应发生情况比较,差异均无统计学意义(P>0.05)。结论小剂量Dex联合阿扎司琼用于术后静脉镇痛可降低女性患者后路腰椎融合术PONV发生率,且不增加不良反应。Objective To evaluate the effects of combined use of dexmedetomidine(Dex)and azasetron in postoperative intravenous analgesia on postoperative nausea and vomiting(PONV)for female patients after lumbar fusion surgery.Methods A total of 180 female patients[aged 18‒65,BMI 18‒30 kg/m^(2),American Society of Anesthesiologists(ASA)statusⅠorⅡ]who were scheduled for posterior lumbar fusion surgery were selected.According to the random table number method,they were divided into three groups(n=60):a Dex and azasetron group(group DA),a Dex group(group D)and an azasetron group(group A).For postoperative analgesia,they were administered with Dex 1.5μg/kg+azasetron 30 mg+sufentanil 2μg/kg,Dex 1.5μg/kg+sufentanil 2μg/kg and azasetron 30 mg+sufentanil 2μg/kg,respectively,before dilution in 100 ml with normal saline.The infusion rate was 2 ml/h.Then,these three groups were compared for the occurrence of nausea,vomiting and remedial anti‑emetics at postoperative 0‒6 h,6‒12 h,12‒24 h,24‒48 h and 0‒48 h.The resting Visual Analogue Scale(VAS)score and Ramsay sedation score at postoperative 6,12,24,48 h were recorded.Furthermore,the time of use of remedial analgesics and adverse reactions(such as hypotension,bradycardia,Ramsay sedation scores≥4,dizziness,headache,abdominal distension,constipation and rashes)within postoperative 48 h were observed Results Compared with group A,group DA showed significantly decreases in postoperative nausea at postoperative 0‒6 h,6‒12 h,24‒48 h and 0‒48 h,de‑creases in vomiting at postoperative 6‒12 h and 0‒48 h(P<0.05),and decreases in the times of use of remedial anti‑emetics(P<0.05),while group D showed increasing incidence of nausea and vomiting at postoperative 0‒6 h(P<0.05).Compared with group D,group DA showed significant decreases in the incidence of nausea at postoperative 0‒6 h,6‒12 h and 0‒48 h(P<0.05),decreases in the incidence of vomiting at postoperative 0‒6 h,6‒12 h and 0‒48 h(P<0.05)and decreases in the times of use of remedial ant

关 键 词：术后恶心呕吐 右美托咪定 阿扎司琼 腰椎手术 

分 类 号：R614[医药卫生—麻醉学]