右美托咪定对腹腔镜子宫切除术患者恶心呕吐的影响

Effect of Dexmedetomidine on Postoperative Nausea and Vomiting in Patients with Laparoscopic Hysterectomy

目的探讨右美托咪定减轻腹腔镜下子宫全切除术患者术后恶心呕吐的效果。方法选择择期行腹腔镜下子宫切除术、美国麻醉学医师协会评分为Ⅰ~Ⅱ级患者180例。随机将患者分为对照组（A组）和右美托咪定组（B组）,每组90例。两组患者常规麻醉诱导,麻醉术中维持均采用维库溴铵、瑞芬太尼和异丙酚。B组给予右美托咪定0.4μg·（kg·h）-1,A组给予同等容量的生理氯化钠溶液。记录患者年龄、体质量、ASA分级、手术时间、麻醉时间及二氧化碳气腹时间;记录麻醉前即刻（T1）、麻醉后即刻（T2）、拔管后即刻（T3）和术后24 h（T4）的平均动脉压（MAP）、心率（HR）和血氧饱和度（Sp O2）情况;记录术后0~2 h、2~12 h和12~24 h的患者恶心和呕吐病患者例数。结果两组患者相比,年龄、体质量、ASA分级、手术时间、麻醉时间和二氧化碳气腹时间,以及不同时间点的MAP、HR和Sp O2无明显差别（P〉0.05）。两组患者术后24 h内恶心呕吐发生率有显著差异（P〈0.05）,术后0~2 h、2~12 h和12~24 h这3个时间段内,B组发生恶心和呕吐的患者少于A组（P〈0.05）。结论右美托咪定可以有效改善腹腔镜手术患者的术后恶心呕吐。

Objective To investigate the effect of dexmedetomidine on postoperative nausea and vomiting in patients with laparoscopic hysterectomy.Methods 180 patients（ASA Ⅰ-Ⅱ） who had undergone selective operations with laparoscopic hysterectomy were randomly divided into 2 groups（90 in each group） ：control group（A）and dexmedetomidine group（B）.All the patients were subjected to anesthesia induction,and anesthesia was maintained by vecuronium,remifentanil and propofol.Patients in group B were given dexmedetomidine 0.4 μg·（kg·h）-1iv while the control patients were given saline of the same volume.The age,body weight and ASA score of patients as well as duration of anesthesia,surgery and CO2 insufflation were recorded.In addition,MAP,HR and Sp O2 were measured before anesthesia（T1）,immediately after anesthesia（T2）,immediately after extubation（T3） and 24 h after surgery（T4）.Moreover,patients with nausea or vomiting at 0-2 h,2-12 h and 12-24 h after surgery were counted.Results There was no significant difference in age,body weight,ASA score,duration of surgery,duration of anesthesia or duration of CO2 insufflation between the two groups（P 〉 0.05）.The incidence of nausea or vomiting in group B was significantly lower than in group A（P 〈 0.05）.Conclusion Dexmedetomidine can reduce the incidence of nausea and vomiting in patients after laparoscopic hysterectomy.