泵注右美托咪定对妇科开腹术后患者疼痛和恢复的影响

Effects of dexmedetomidine on postoperative analgesia and recovery for patients with gynecologic laparotomy

目的研究术中泵注右美托咪定对妇科开腹术后疼痛和恢复的影响。方法选取2016年1月—2017年12月在西南医科大学附属中医医院行全身麻醉妇科开腹手术患者64例。随机分为丙泊酚/瑞芬太尼/右美托咪定组(PRD组)和丙泊酚/瑞芬太尼/生理盐水组(PRS组),每组32例。术中记录两组患者平均动脉压(MAP)、心率(HR)及脑电双频指数(BIS)。术后收集Ramsay镇静评分、视觉模拟评分(VAS)、自控镇痛及术后恢复情况。结果两组患者临床特征(年龄、体重及体重指数)、手术时间、麻醉时间及麻醉后恢复室停留时间比较,差异无统计学意义(P>0.05);但围手术期不同时间点MAP、HR有差别,其变化趋势有差别(P<0.05)。PRD组患者围手术期MAP较PRS组更低,HR较PRS组更慢(P<0.05)。两组患者不同时间点、随时间变化趋势麻醉深度有差别(P<0.05)。PRD组患者术中BIS值更低,拔管后Ramsay镇静评分更高(P<0.05)。两组患者不同时间点、随时间变化趋势静息和运动VAS评分有差别(P<0.05)。PRD组患者术后24 h自控静脉镇痛药物消耗量更少,且VAS评分更低(P<0.05)。PRD组患者术后恢复问卷调查评分较PRS组更高(P<0.05)。两组患者术后不良反应比较,差异无统计学意义(P>0.05)。结论右美托咪定可增强妇科开腹手术患者术后镇痛效果,促进术后快速康复。

Objective To investigate effects of dexmedetomidine on postoperative analgesia and recovery for patients with gynecologic laparotomy Methods Selected 64 patients undergoing gynecologic laparotomy with general anesthesia were randomly divided into propofol/remifentanil/dexmedetomidine(PRD)group and propofol/remifentanil/normal saline group(PRS),32 cases in each group.The mean arterial pressure(MAP),heart rate(HR)and EEG bispectral index(BIS)were recorded during the operation.The Ramsay sedation score,the VAS score,the PCA situation and the postoperative recovery were collected.Results There was no significant differences in clinical characteristics(age,weight and BMI),operation time,anesthesia time and PACU time between PRS and PRD groups(P>0.05).There were differences in heart rate and mean arterial pressure between the two groups at different time(P<0.05).Compared with PRS group,PRD group had lower perioperative heart rate and mean arterial pressure(P<0.05).The depth of anesthesia at different time points and the change trend were different in two groups(P<0.05).The BIS was lower and Ramsay sedation score was higher after extubation in PRD group(P<0.05).At different time points,the scores of resting and motor visual analogue scores were different between the two groups,and the change trend was different(P<0.05).The patients in PRD group consumed less analgesics 24 hours after operation and had lower VAS score(P<0.05).The score of recovery questionnaire in PRD group was higher than that in PRS group(P<0.05).There was no significant difference in adverse reactions between in two groups(P>0.05).Conclusion Dexmedetomidine can enhance the analgesic effect and promote the rapid recovery after gynecologic laparotomy.