地塞米松联合右美托嘧啶在妇科腹腔镜手术术后镇痛中的应用

Application of dexamethasone combined with dexmedetomidine for analgesia after gynecological laparoscopic surgery

目的探讨小剂量地塞米松联合右美托咪啶应用于妇科全麻下腹腔镜手术术后镇痛对患者术后恶心呕吐和镇痛效果的影响。方法选取2016年2月至2017年8月在安徽省肿瘤医院妇瘤科接受全身麻醉下腹腔镜子宫肌瘤剔除术治疗的140例子宫肌瘤患者,采用随机数表法将患者分为右美托嘧啶组(n=70)与右美托嘧啶+地塞米松组(联合治疗组,n=70),右美托嘧啶组在术后行右美托嘧啶静脉自控镇痛泵(PCIA),联合治疗组术后行地塞米松+右美托嘧啶静脉自控镇痛泵(PCIA)进行术后镇痛。比较两组患者术后0~30 min、30 min^6 h、6~12 h、12~24 h、24~48 h的恶心呕吐(PONV)发生率及严重程度,比较两组患者术后30 min、6 h、24 h、48 h疼痛视觉模拟评分(VAS)、镇痛泵按压次数及不良反应发生情况。结果联合治疗组在30 min^6 h、6~12 h、12~24 h、24~48 h时间段内PONV发生率和严重程度较右美托咪啶组低,差异均有统计学意义(P<0.05);两组患者在术后30 min、6 h、24 h、48 h的VAS评分比较差异均无统计学意义(P>0.05);联合治疗组患者在0~6 h、6~12 h、12~24 h、24~48 h单位时间内镇痛泵按压次数低于右美托嘧啶组,差异有统计学意义(P<0.05);治疗期间联合治疗组不良反应总发生率为8.57%,略低于右美托咪啶组的15.71%,但差异无统计学意义(P>0.05)。结论小剂量地塞米松联合右美托咪啶应用于妇科全麻下腹腔镜手术术后镇痛可减少患者恶心呕吐的发生率,并可显著降低术后患者单位时间内镇痛泵的按压次数,治疗效果比单纯右美托咪啶更佳。

Objective To investigate the effect of low-dose dexamethasone combined with dexmedetomidine for postoperative analgesia on postoperative nausea and vomiting and analgesia in patients who received laparoscopic gynecologic surgery under general anesthesia. Methods A total of 140 patients with uterine fibroids receiving laparoscopic myomectomy under general anesthesia in the Department of Gynecologic Oncology in Anhui Provincial Cancer Hospital from February 2016 to August 2018 were selected, who were divided into a dexmedetomidine group（n=70） and a dexmedetomidine ＋ dexamethasone group（combination therapy group, n=70） by the random number table method. In dexmedetomidine group, postoperative analgesia was performed with dexmedetomidine via patient-controlled intravenous analgesia（PCIA） pump after operation, and patients in combination therapy group was treated with dexmedetomidine＋ dexamethasone PCIA. The incidence and severity of postoperative nausea and vomiting（PONV） were compared between the two groups at different time-points： 0-30 min, 30 min-6 h, 6-12 h, 12-24 h, and 24-48 h. The Visual Analog Scale（VAS） score, the number of analgesic pump compressions, and the incidence of adverse reactions were compared between the two groups at 30 min, 6 h, 24 h, and 48 h. Results The incidence and severity of PONV in the combination therapy group were significantly lower than those in the dexmedetomidine group at 30 min-6 h, 6-12 h, 12-24 h,and 24-48 h（P〈0.05）. There was no significant difference in VAS scores between the two groups at 30 min, 6 h, 24 h, and48 h after surgery（P〉0.05）. The number of analgesic pump compressions in the combination therapy group was significantly lower than that of the dexmedetomidine group within the time unit： 0-6 h, 6-12 h, 12-24 h, and 24-48 h（P〈0.05）.The overall incidence of adverse reactions in the combination therapy group was 8.57% during the treatment period, slightly lower than that of 15.71% in the dexmedetomidine group, but the difference was not statistically significant（P〉0.05）.Conclusion Low-dose dexamethasone combined with dexmedetomidine for postoperative analgesia can effectively reduce the incidence of nausea and vomiting after gynecological laparoscopic surgery under general anesthesia, and can significantly reduce the number of analgesic pump compressions in unit time after surgery. Its therapeutic effect is better than that of dexmedetomidine alone.