右旋美托咪定在老年人腹腔镜胆囊切除术的超前镇痛作用

The Preemptive Analgesia with Intravenous Dexmedetomidine after Laparoscopic Cholecystectomy Elderly

目的：观察麻醉前注入右旋美托咪定（DEX）对老年人术后镇痛的影响。方法：选择按照美国麻醉师协会（ASA）分级为I或Ⅱ级,在全身麻醉下行腹腔镜胆囊切除术的40例患者,年龄60~72岁,患者随机分为D、C两组,每组20例。D组麻醉诱导前静脉泵注入DEX1.0μg/kg,10min输注完毕,C组麻醉诱导前给予咪达唑仑50μg/kg,静脉注射。两组在术后用相同的静脉镇痛的方式：芬太尼16μg/kg,以0.9%氯化钠液稀释到100mL注入PCIA泵,两组PCIA泵注射速度均为2mL/h持续泵入,单次自控量0.5mL,锁定时间为15min。术后行视觉模拟评分（VAS）、监测生命体征、平均动脉压、Ramsay镇静评分,并且观察记录患者嗜睡、头晕、恶心、呕吐、呼吸抑制等不良反应的发生。结果：多个时间点D组VAS评分显著低于C组（P〈0.05）,而Ramsay评分显著高于C组（P〈0.05）,警觉/镇静（OAA/S）评分显著高于C组（P〈0.05）,不良反应包括头晕、呼吸抑制以及需要加服止痛药的例次数,D组均低于C组。恶心、呕吐的发生率两组无显著差异。结论：右美托咪定作为全麻诱导辅助用药具有一定的超前镇痛作用,恶心、呕吐、呼吸抑制等不良反应相对较小,并可减少术后阿片类麻醉性镇痛药的用量。

Objective：To study the effect of low-dose ketamine combined buprenorphine for the elderly during laparoscopic cholecystectomy（LC） after analgesia.Methods： Fourty elderly patients with LC operation,aged 60 to 72years,were randomly classified two groups： Group D（n=20）which apply Dexmedetomidine 1.0μg/kg in 10 min before anesthesia,and Group C（n=20）groups received midazolam 50μg/kg.Two groups in postoperative analgesia in the same manner： fentanyl 16μg·kg that were diluted to 100 mL normal saline into the PCA pump,injection rate of 2 mL/h single-controlled volume 0.5 mL,lockout time 15 min,monitored visual analogue scale（VAS）,mean arterial pressure,ramsay sedation score and observed hypersomina,dizziness,nausea,vomiting,respiratory depression and other adverse reactions.Results：Multiple times and Group D VAS scores were significantly lower than the group C（P0.05）,and ramsay scores were significantly higher than the Group C（P0.05）,OAA/S scores were significantly higher than the Group C（P0.05）.The other adverse reactions,including dizziness,respiratory inhibition,need to increase the number of cases serving painkillers,Group D were lower than the Group C.Nausea and vomiting of no significant difference between the two groups.Conclusions：Dexmedetomidine as anesthesia adjuvants have preemptive analgesia for elderly postoperative analgesia and its side effects with vomiting,respiratory inhibition are relatively small and reduces postoperative opioid consumption,