摘要目的 探讨小剂量右美托咪定对妇科腹腔镜手术患者术后恶心呕吐发生的影响.方法 选择全身麻醉下行妇科腹腔镜手术患者207例,年龄18～60岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组:右美托咪定组(D组,n=103)和对照组(C组,n=104).麻醉诱导前,D组经1 min静脉注射右美托咪定0.1 μg/kg,C组给予等容量生理盐水.手术结束前20 min,D组经30 s静脉注射右美托咪定0.04 μg/kg.对于要求PCA的患者,镇痛药物配方为舒芬太尼125 μg,生理盐水稀释至125 ml,背景输注速率1 ml/h,PCA剂量2 ml,锁定时间8 min.未要求PCA的患者术后采用哌替啶镇痛.维持术后NRS评分不高于4分.PACU期间采用静脉注射舒芬太尼3μg进行补救镇痛.记录术后0～1h、1～6h、6～12h及12～24 h内恶心呕吐的发生情况.记录术中低血压、心动过缓的发生情况、苏醒时间及入PACU时的Ramsay镇静评分、PACU期间舒芬太尼补救镇痛情况、PCA使用情况、止吐药使用情况、嗜睡和寒战的发生情况.结果 2组未要求PCA的患者均未使用哌替啶.2组均未见寒战和嗜睡发生.与C组比较,D组心动过缓发生率升高,PACU期间止吐药使用率降低,术后1h内恶心、呕吐发生率降低(P＜0.05),苏醒时间、Ramsay镇静评分、舒芬太尼补救镇痛率、PCA使用率和术后总恶心呕吐发生率差异无统计学意义(P＞0.05).结论 对于妇科腹腔镜手术患者,小剂量右美托咪定仅可降低术后早期(PACU期间)恶心呕吐的发生,且不影响麻醉恢复.

abstractsObjective To investigate the effect of small dose of dexmedetomidine on the development of postoperative nausea and vomiting in the patients undergoing laparoscopic gynecologic surgery.Methods A total of 207 patients,aged 18-60 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic gynecologic surgery under general anesthesia,were randomly divided into either dexmedetomidine group (group D,n=103) or control group (group C,n=104) using a random number table.Before induction of anesthesia,dexmedetomidine 0.1 μg/kg was injected intravenously over 1 min in group D,while the equal volume of normal saline was given instead in group C.At 20 min before the end of surgery,dexmedetomidine 0.04 μg/kg was injected intravenously over 30 s in group D.For the patients requiring patient-controlled analgesia (PCA),PCA solution contained sufentanil 125 μg in 125 ml of normal saline.The PCA pump was set up with a 2 ml bolus dose,a 8 min lockout interval and background infusion at a rate of 1 ml/h.Pethidine was used for PCA after surgery in the patients who did not require PCA.Numeric rating scale scores were maintained ＜4 after surgery.Sufentanil 3 μg was injected intravenously as rescue analgesic in postanaesthesia care unit (PACU).The occurrence of nausea and vomiting was recorded within 0-1 h,1-6 h,6-12 h,and 12-24 h periods after surgery.The occurrence of hypotension and bradycardia during surgery,emergence time,Ramsay sedation score on admission to PACU,requirement for sufentanil as rescue analgesic in PACU,requirement for PCA and antiemetics,and occurrence of somnolence and shivering were recorded.Results Pethidine was not given in the patients who did not require PCA in the two groups.Somnolence and shivering were not found in the two groups.Compared with group C,the incidence of bradycardia was significantly increased,the requirement for antiemetics in PACU and incidence of nausea and vomiting within 1 h after surgery were significantly decreased (P＜0.05),and no significant change was found in the emergence time,Ramsay sedation score,requirement for sufentanil as rescue analgesic,requirement for PCA and total incidence of postsurgical nausea and vomiting in group D (P＞0.05).Conclusion For the patients undergoing laparoscopic gynecologic surgery,small dose of dexmedetomedine can only decrease the development of nausea and vomiting in the early postsurgical period (in PACU),and does not influence the recovery from anesthesia.