目的 观察舒芬太尼复合右美托咪啶在妇科腔镜手术术后镇痛的效果.方法 选择ASA Ⅰ或Ⅱ级择期行妇科腔镜手术患者60例,随机均分三组:Ⅰ组术后镇痛给予舒芬太尼1.5μg·kg-1·d-1,Ⅱ组舒芬太尼1.0μg·kg-1·d-1,Ⅲ组舒芬太尼1.0μg·kg-1·d-1+右美托咪定1.0μg·kg-1·d-1.三组术后镇痛持续量2 ml/h,单次负荷剂量2 ml,锁定时间15 min,总容量100 ml.采用疼痛VAS评分评价三组术毕(T1)及术后6 h(T2)、12 h(T3)、24 h(T4)与48 h(T5)疼痛程度及各时段自控镇痛按压次数,记录不良反应发生率.结果 三组术后各时点疼痛VAS评分均＜4分,T2～T5时Ⅱ组疼痛VAS评分显著高于Ⅰ、Ⅲ组(P＜0.05)；0～6 h、6～12 h、12～24 h时Ⅱ组自控按压次数明显多于Ⅰ、Ⅲ组(P＜0.05).Ⅰ组恶心呕吐发生率高于Ⅱ、Ⅲ组(P＜0.05).结论 右美托咪定妇科腔镜手术术后镇痛可减少舒芬太尼使用量,同时降低其恶心呕吐的发生率,但心动过缓发生率增高.%Objective To observe the effect of sufentanl combined with dexmedetomidine on postoperative analgesia in patients undergoing gynecological laparoscopic surgeries. Methods Sixty patients with ASA physical status I or Ⅱ undergoing elective gynecological laparoscopic surgeries were randomly divided into three groups with 20 each: group I received sufentanil 1. 5 μg·kg-1 ? D-1 , group H received sufentanil 1. 0 μg·kg-1 ?d-1, group Ⅲ received sufentanil 1. 0 μg·kg-1·d-1 + dexmedetomidine 1.0 μg·kg-1 ·d-1. The analgesic pump was set in the three groups as follows: continuous perfusion rate 2 ml/h, single bolus 2 ml, lockout time 15 min, total volume 100 ml. Pain intensity was assessed with visual analog scale (VAS) at the immediate time after operation (Ti) and 6h (T2), 12 h (T3), 24 h (T4) and 48 h (T5) after operatioa The number of patient-controlled press of the pump and the incidence of side effects were recorded. Results VAS scorings of the three groups at all the time points were less than 4, but group Ⅱ at T2-T5 displayed higher pain intensity than that of the groups I and El (P<0. 05) , and the number of self-controlled press of the pump in group TJ was markedly more than groups I and 1 at 0-6 h, 6-12 h, 12-24 h(P<0. 05). The incidence of nausea and vomiting in group I was higher than groups II and IE (P<0. 05). Conclusion Dexmedetomidine can reduce postoperative consumption of sufentanil in patients undergoing gynecological laparoscopic surgeries, and decrease the incidence of nausea and vomiting.
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