右美托咪定对舒芬太尼术后静脉镇痛患者恶心呕吐的影响

Effect of Dexmedetomidine on preventing nausea and vomiting in patients with Sufentanil for postoperative intravenous analgesia

目的观察右美托咪定(DEX)对舒芬太尼术后静脉镇痛患者恶心呕吐(PONV)的影响。方法选择2015年1月~2016年6月于武警四川省总队医院择期行后路脊柱融合术患者100例,采用随机数字表法分为舒芬太尼组(S组)和DEX复合舒芬太尼组(SD组),每组各50例。SD组患者术毕前30 min静脉注射DEX 0.5μg/kg,术后静脉镇痛为DEX 2μg/kg+舒芬太尼2μg/kg。S组术毕前30 min给予生理盐水,术后静脉镇痛为舒芬太尼2μg/kg。记录两组PONV发生率和严重程度、术后48 h内追加舒芬太尼总量、甲氧氯普胺用量及疼痛评分。结果术后>1~3 h SD组患者PONV发生率显著低于S组(P<0.01);术后>1~3、>3~6 h和>6~12 h SD组发生中重度PONV患者比例显著低于S组(P<0.05);SD组患者术后1、3 h静息和活动时疼痛评分均显著低于S组(P<0.05),术后48 h内追加舒芬太尼剂量也显著低于S组(P<0.05)。两组患者术后48 h内低血压和/或心动过缓的发生率差异无统计学意义(P>0.05)。结论 DEX对舒芬太尼术后静脉镇痛引起的PONV有预防作用。

Objective To study the effect of Dexmedetomidine on preventing nausea and vomiting （PONV） in patients with Sufentanil for postoperative intravenous analgesia. Methods 100 patients underwent posterior lumbar spinal fusion in Chinese People＇s Armed Police Corps Hospital in Sichuan Province from January 2015 to June 2016 were recruited. All patients were allocated into group Sufentanil （group S） and group Sufentanil-Dexmedetomidine （group SD） by ran- dom number table, each group had 50 cases. Patients in group SD received Dexmedetomidine 0.5 μg/kg intravenously 30 min before the completion of surgery, and Sufentanil 2 μg/kg plus Dexmedetomidine 2 μg/kg made up to a total volume of 100 mL for postoperative intravenous analgesia. Normal saline was injected 30 rain before the end of surgery, and then Sufentanil 2 μg/kg was made up to a total volume of 100 mL for analgesia in group S. The incidence and severity of PONV, cumulative dose of Sufentanil for rescue analgesia and Metoclopramide in the first 48 h after surgery were recorded. Pain scores were assessed for 48 h. Results Patients in group SD had less PONV during the time inter- val 〉1-3 h postoperatively compared with group S （P 〈 0.01）. The proportions of patients suffered from moderate to se- vere PONV in group SD during 〉1-3, 〉3-6 h and 〉6-12 h after surgery were significantly lower than those in group S （P 〈 0.05）. Pain scores of group SD at 1 h and 3 h after surgery were lower significantly than those of group S at rest and with moving （P 〈 0.05）. Compared with group S, dose of Sufentanil for rescue analgesia in the first 48 h after surgery was significantly lower in group SD （P 〈 0.05）. Incidence of hypotension and/or bradycardia between group SD and group S was not different significantly （P 〉 0.05）. Conclusion Dexmedetomidine can prevent PONV induced by Sufentanil for postoperative analgesia,