右美托咪定联合哌替啶在腰硬联合麻醉下腹腔镜手术患者肩部不适的研究

The Study of Dexmedetomidine Combined with Pethidine in Reducing Shoulder Pain Caused by Laparoscopic underwent Combined Spinal-epidural Anesthesia

目的：观察右美托咪定联合哌替啶在缓解腰硬联合麻醉后下腹部腔镜手术中肩部不适的有效性。方法：ASA分级Ⅰ、Ⅱ级,在腰硬联合麻醉下行下腹部腹腔镜手术且手术时间在90 min以内手术患者60例,年龄20~50岁,布比卡因13 mg,麻醉平面胸4水平,按照随机数字表法分为三组,每组20例,A组：手术前10 min哌替啶0.8 mg/kg静注,右美托咪定1.0μg/kg静脉泵入,10 min后改为0.5μg/（kg·h）;B组：哌替啶0.8 mg/kg静注,以相同剂量的生理盐水代替右美托咪定静脉泵入;C组：静注与A组相同剂量的生理盐水代替哌替啶,右美托咪定1.0μg/kg静脉泵入,10 min后改为0.5μg/（kg·h）。记录手术开始前（T1）、气腹开始后10 min（T2）、30 min（T3）、60 min（T4）的平均动脉压（MAP）、心率（HR）,并评定患者肩部不适的发生情况。结果：与手术开始前比较,气腹后B、C组血压明显升高,心率明显增快,A组血压、心率变化较小。气腹后A组肩部不适的发生率、严重程度明显低于B、C组（P〈0.05）。结论：在腰硬联合麻醉腹腔镜手术中联合使用右美托咪定和哌替啶能够降低肩部不适的发生率和严重程度。

Objective：To observe the effects of dexmedetomidine combined with pethidine alleviating shouler pain caused by laparoscopic underwent combined spinal-epidural anesthesia. Method：Sixty patients between 20 and 50 years,ASA class 1–2,scheduled for lower abdominal laparoscopy underwent combined spinal-epidural anesthesia were included in the study.Paintients were randomly assigned into three groups.Group A：patients were injected with pethidine 0.8 mg/kg i.v.and infused with dexmedetomidine 1.0 μg/kg, and then 0.5 μg/（kg·h）after 10 minutes.Group B： patients were injected with pethidine 0.8mg/kg i.v.,normal saline was infused at the rate of dexmedetomidine in group A.Group C：patients were injected normal saline with the same dose insted of pethidine,and infused with dexmedetomidine 1.0 μg/kg, and then 0.5 μg/（kg·h）after 10 minutes.MAP,HR and shoulder pain were recorded during the operation. Result： MAP rose, HR increased after pneumoperitoneum in group B and,however kept steady group C.The incidence and severity of shoulder pain was lower in group A than in group B and in group C.Conclusion：Dexmedetomidine combined with pethidine could reduce the incidence and severity of shoulder pain caused by lower abdominal laparoscopy underwent combined spinal-epidural anesthesia.