右美托咪啶对胃癌根治术后吗啡病人自控静脉镇痛效果的影响

Effect of dexmedetomidine on efficacy of PCIA with morphine after gastrectomy

目的评价右美托咪啶对胃癌根治术后吗啡病人自控静脉镇痛效果的影响。方法择期拟行胃癌根治术的病人120例，年龄41～64岁，ASA分级I或Ⅱ级，采用随机数字表法分为2组（n=60）：吗啡组（M组）和吗啡＋右美托眯啶组（MD组）。于手术结束即刻行病人自控静脉镇痛，M组采用吗啡100mg，MD组采用吗啡100mg＋右美托咪啶200Mg，均用生理盐水稀释至200ml，负荷剂量6ml，背景输注速率1ml／h，单次给药剂量3ml，锁定时间10min，维持VAS评分≤4分，Ramsay评分2～3分。记录术后24和48h内吗啡用量、PCA总按压次数和有效按压次数；记录术后镇痛期间恶心、呕吐、瘙痒、心动过缓、低血压、镇静过度和呼吸抑制等不良反应的发生情况。结果与M组比较，MD组术后24和48h内吗啡用量、PCA总按压次数和有效按压次数降低，术后恶心、呕吐和瘙痒的发生率降低（P〈0．05）。两组均未发生心动过缓、低血压、过度镇静和呼吸抑制。结论右美托咪啶可增强胃癌根治术后吗啡病人白控静脉镇痛的效果，且不良反应少。

Objective To evaluate the effect of dexmedetomidine on the efficacy of patient-controlled intravenous analgesia （PCIA） with morphine after elective radical gastrectomy. Methods One hundred and twenty ASA T or II patients aged 41-64 yr weighing 50-80 kg undergoing elective radical gastrectomy were randomly divided into 2 groups of 60 patients, according to the composition of PCIA solution ： group I morphine （group M） and group II morphine ＋ dexmedetomidiue （group MD） . In group M the PCIA solution contained morphine 100 mg in 200 ml of normal saline （NS）, while in group MD the PCIA solution contained morphine 100 mg ＋ dexmedetomidine 200 ug in NS 200 ml. PCIA was started immediately after operation. A loading dose of 6 ml was given iv at the end of operation. PCIA setting was as follows： background infusion 1 ml/h, bolus dose 3 ml and lockout interval 10 rain. VAS score was maintained at ≤4 and Ramsay score at 2-3. The total amount of morphine consumed, the number of attempts and successfully delivered doses within 24 and 48 h after operation were recorded. Postoperative complications including nausea, vomiting, bradycardia, hypotension, oversedation and respiratory depression were recorded. Results The total amount of morphine consumed, the number of attempts and successfully delivered doses within 24 and 48 h after operation were significantly smaller and the incidence of nausea and vomiting and pruritus was significantly lower in group MD than in group M. No bradycardia, hypotension, oversedation or respiratory depression was observed in either group. Conclusion Dexmedetomidine added to intravenous morphine PCA can improve the analgesic efficacy after radical gastrectomy with less adverse effects.