腹腔镜全子宫切除术中预注右美托咪定对术后舒芬太尼PCSA的影响

摘要

目的：探讨在腹腔镜全子宫切除术中预注右美托咪定对术后舒芬太尼PCSA（患者自控皮下镇痛）的影响。方法选择妇科腹腔镜全子宫切除术患者60例，随机分为两组，两组分别为30例患者。患者年龄、身高、体质量差异均无统计学意义（P<0.05）。A组（右美托咪定组）和B组（对照组）。A组患者在手术开始以0.1µg/(kg•h)泵注右美托咪定并在手术结束前10 min停止泵注，B组以同样方式泵注等量生理盐水。两组患者手术结束后均带PCSA来镇痛。B组PCSA中含舒芬太尼2.5µg/kg+氯普鲁卡因0.6 g+氟哌利多5 mg加生理盐水到100 mL。A组PCSA中舒芬太尼的剂量通过观察术后不良反应的变化随时调整。背景剂量：5 mL/h，负荷剂量：3 mL，锁定间隔时间：15 min。记录术后PCSA舒芬太尼用量及患者恶心、呕吐和寒颤的发生情况。结果与B组PCSA相比较，A组PCSA中的舒芬太尼从2.5µg/kg减少到2.0µg/kg，同样使患者得到满意的镇痛效果。A组（右美托咪定组）的恶心、呕吐等不良反应明显低于B组（对照组）（P<0.05）。结论腹腔镜全子宫切除术中以0.1µg/(kg•h)预注右美托咪定可以减少术后PCSA中舒芬太尼用量，而且可使患者恶心、呕吐等不良反应的发生率大大降低。%Objective To investigate the hysterectomy in pre-injection given dexmedetomidine influence on postoperative sufentanil PCSA (patient-controlled analgesia subcutaneously) in laparoscopy.Methods 60 cases of laparoscopic hysterectomy surgery were randomly divided into two groups of 30 patients, respectively, age, height, weight difference was not statistically significant (P>0.05). A group (dextromethorphan detomidine group) and group B (control group). A group of patients at the start of surgery to 0.1 µg/(kg•h) dexmedetomidine infusion set and 10 min before the end of surgery to stop pumping, group B in the same way normal saline infusion. After both groups of patients with surgery PCSA to analgesia. Group B PCSA containing sufentanil 2.5 µg/kg, chloroprocaine 0.6 g and droperidol 5 mg plus saline to 100 mL. A group PCSA changes in dose sufentanil through adverse reactions observed at any time after the adjustment. Background dose: 5 mL/h, loading dose: 3 mL, lock interval: 15 min. Postoperative PCSA sufentanil dosage and patient nausea, vomiting and chills of occurrence.Result The results compared with B group PCSA, A group of sufentanil PCSA from 2.5 µg/kg reduced to 2 µg/kg, so that patients get the same satisfaction analgesic effect, while the A group (dexmedetomidine given group) nausea, vomiting and other adverse reactions was significantly lower than in group B (control group) (P<0.05).Conclusion Laparoscopic hysterectomy to 0.1 µg/(kg•h) pre-injection given dexmedetomidine can not only reduce the amount of postoperative sufentanil PCSA and allows patients nausea, vomiting incidence of adverse reactions is greatly reduced.