右美托咪定用于预防腹腔镜胆囊切除术后恶心呕吐的效果

Effect of dexmedetomidine on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

目的观察右美托咪定预防腹腔镜胆囊切除术后恶心呕吐的效果。方法选择择期行腹腔镜胆囊切除术的患者70例,男17例,女53例,年龄20~65岁,ASAⅠ或Ⅱ级。随机分为两组:右美托咪定组(R组)和地塞米松组(D组),每组35例。R组于麻醉诱导前静脉注射右美托咪定,背景剂量为0.5μg/kg,10min内注射完毕,后以0.5μg·kg^(-1)·h^(-1)维持输注。D组给予地塞米松8mg静脉注射。观察患者入室(T_1)、插管前(T_2)、插管后5min(T_3)、手术开始后5 min(T_4)、手术开始后30min(T_5)、缝皮时(T_6)、拔管后5min(T_7)的血压和心率。记录术中七氟醚的吸入浓度、停七氟醚至拔管的时间、手术时间及麻醉时间。观察患者8、24、48h内有无发生恶心呕吐。结果两组患者术后8、24、48h的恶心发生率和呕吐发生率差异无统计学意义。T2~T7时R组HR明显低于D组(P<0.05),两组间MAP差异无统计学意义。结论与静脉注射地塞米松8mg比较,静脉注射右美托咪定负荷量0.5μg/kg(10min),维持量0.5μg·kg^(-1)·h^(-1),对减少腹腔镜胆囊术后恶心呕吐的发生有相同的效果。

Objective To observe the effectiveness of dexmedetomidine on postoperative nausea and vomiting （PONV） in patients undergoing laparoscopic cholecystectomy.Methods Seventy patients （17 males,53 females,aged 20-65 years,ASA grade Ⅰ or Ⅱ） undergoing laparoscopic cholecystectomy were randomized to receive either dexmedetomidine （group R,n=35） or dexamethasone （group D,n=35）.The patients in the group R received 0.5 μg/kg bolus dose and maintenance dose at the rate of 0.5 μg·kg-1·h-1 of dexmedetomidine before intubation.The patients in the group D received 8 mg dexamethasone before intubation.The BP and HR were recorded at the following points： on arrival in the operating room （T1）,before intubation （T2）,5 minutes after intubation （T3）,5 minutes after the beginning of the operation （T4）,30 minutes after the beginning of the operation （T5）,at the end of operation （T6） and 5 minutes after extubation （T7）.The inhaling concentration of sevoflurane,extubation time,operation time and anesthesia time were recorded.The incidence of nausea and vomiting were recorded at 8,24,48 hours after operation.Results The incidence of nausea and vomiting at each point were similar between two groups.The HR at T2-T7 in group D was significantly lower.But MAP was similar between two groups.Conclusion 0.5 μg/kg bolus dose and maintenance dose at the rate of 0.5 μg·kg-1·h-1 of dexmedetomidine reduced the incidence of PONV in patients undergoing laparoscopic cholecystectomy,similar to dexamethasone.