右美托咪定对子宫切除术后地佐辛自控镇痛效果的影响

Effect of dexmedetomidine on postoperative pain in patients receiving patient controlled intravenous analgesia with dezocine after hysterectomy

目的探讨右美托咪定（dexmedetomidine，Dex）对子宫切除术后地佐辛患者自控静脉镇痛效果的影响。方法择期拟行经腹子宫切除术的患者60例，年龄40岁～65岁，身高155em～170cm，体重49kg-75kg，美国麻醉医师学会（ASA）分级I或Ⅱ级，采用随机数字表法分为两组（每组30例）：地佐辛组（D组）、Dex和地佐辛组（DD组）。DD组术毕前30min缓慢静脉泵注（15min）Dex0．8μg／kg，D组静脉给予同等容量的生理盐水。两组均在术毕前10min静脉注射地佐辛5mg、托烷司琼2mg，手术结束后行地佐辛患者自控静脉镇痛，地佐辛30mg、托烷司琼8mg用生理盐水稀释至150ml，背景输注速率3ml／h，白控给药剂量3ml，锁定时间15min。于术后4、8、24、48h记录视觉模拟评分（viaual analogue scale，VAS）、镇静评分（rainsay sedation scores）、追加镇痛药例数、镇痛泵按压次数；记录术后48h内恶心、呕吐、瘙痒、心动过缓、低血压和呼吸抑制等副作用发生情况。结果DD组术后4、8hVAS评分[2（1～2）、2（1-2）]和镇痛泵按压次数[1（0-1）、0（0～1）]均低于同时点D组[3（2-3）、2（2～3）]和[1（1—2）、1（0～2）]（P〈0．05）。DD组术后48h内恶心、呕吐的发生率3％、0％明显低于D组10％、3％（P〈0．05）。结论术毕前30min缓慢静脉泵注（15min）Dex0．8Ixg／kg可增强地佐辛患者自控静脉镇痛效果，且副作用少。

Objective To evaluate the effect of dexmedetomidine （Dex） on postoperative pain in patients receiving patient controlled intravenous analgesia with dezocine after hysterectomy. Methods Sixty ASA I or II patients undergoing elective abdominal hysterectomy,aged 40 y-65 y,weighing 49 kg-75 kg were randomly divided into 2 groups （n=30）： group dezocine （group D）, group Dex and dezocine （group DD）. Dezocine 5 mg and tropisetron 2 mg were given in both groups at 10 min before the end of the operation. Patient controlled intravenous analgesia was performed with dezocine 30 mg＋tropisetron 8 mg in 150 ml of normal saline after operation （background infusion at 3 ml/h with a bolus dose of 3 ml and a 15 min lockout interval）. Dex 0.8 μg/kg was given in 15 min in group DD by pumped infusion 30 rain before the operation finished,while normal saline was given in group D. Viaua] analogue scale （VAS）, Ramsay sedation scores, the number of patiengs requiring rescue analgesics and the number of pressing the patient controlled intravenous analgesia button were recorded at 4, 8, 24, 48 h after operation. Postoperative complications including nausea,vomiting,itching,bradycardia,hypotension,and respiratory depression were recorded. Results The VAS scores and times of pressing the patient controlled intravenous analgesia button were lower at 4 h and 8 h after surgery in group DD [2（i-2）, 2（1-2）] and El（0-1）, 0（0-1）] than in group D ~3（2-3）, 2（2-3）] and [1（1-2）, 1（0-2）]（P〈0.05）. The incidence of nausea and vomiting in group DD [3%, 0%] was less than the group D ~10%, 3%] after surgery （P〈0.05）. Conclusions Dex with a single dose of 0.8 p,g/kg （given 15 rain by pumped infusion） 30 rain before operation finished can significantly improve the postoperative analgesic effect of patient controlled intravenous analgesia with dezocine with less adverse effects .