羟考酮复合右美托咪定在腹腔镜全子宫切除术后镇痛中的应用

Application of oxycodone combined with dexmedetomidine in analgesia after laparoscopic hysterectomy

目的观察羟考酮复合右美托咪定用于腹腔镜全子宫切除术术后镇痛的安全性和有效性。方法回顾性分析2015年1月至2016年1月在成都市妇女儿童中心医院的60例全麻下行腹腔镜全子宫切除术患者的临床资料,按照术后用药方法不同分为两组,每组30例,羟考酮复合右美托咪定组为QD组,仅用羟考酮组为Q组,QD组术后镇痛采用羟考酮20 mg复合右美托咪定1. 5μg/kg,Q组采用羟考酮30 mg,分析术后2、8和24 h疼痛视觉模拟(visual analog scales,VAS)评分、Ramsay镇静评分;记录补救性镇痛药羟考酮的患者数;比较两组镇痛满意度以及不良反应。结果两组术后2、8和24 h VAS评分、Ramsay镇静评分比较差异均无统计学意义(P> 0. 05),QD组患者镇痛满意度高于Q组(P <0. 05),QD组恶心、呕吐发生率和头晕嗜睡发生率低于Q组(P <0. 05)。结论羟考酮复合右美托咪定1. 5μg/kg用于腹腔镜全子宫切除术后镇痛减少了羟考酮的用药量,降低了恶心、呕吐和头晕的发生率,镇痛满意度高。

Objective To observe the safety and efficacy of oxycodone combined with dexmedetomidine for postoperative analgesia after laparoscopic hysterectomy. Methods 60 patients scheduled for laparoscopic hysterectomy surgeries under general anesthesia from January 2015 to January 2016 in Chengdu Women and Children Central Hospital were divided into oxycodone combined with dexmedetomidine group （ group QD） and oxycodone group （ group Q） according to different methods of medication after operation. The postoperative analgesia in the QD group was treated with oxycodone 20 mg and dexmedetomidine 1.5 μg/kg. The Q group was treated with oxycodone 30 mg. The VAS score and Ramsay sedation score were analyzed at 2, 8 and 24 h after surgery. The number of patients with the salvage analgesic oxycodone was recorded; the analgesic satisfaction and adverse reactions were compared. Results There were no significant differences in VAS scores and Ramsay sedation scores between the two groups at 2, 8 and 24 h after surgery. The analgesic satisfaction of the QD group was higher than that of the Q group （ P 〈 0. 05）. The incidence of nausea, vomiting, dizziness and drowsiness in the QD group was lower than those of the Q group （P 〈 0. 05）. Conclusion Compound dexmedetomidine 1.5 μg/kg for analgesia after laparoscopic hysterectomy can reduce the dose of oxycodone, the incidence of nausea, vomiting and dizziness with high satisfaction.