右美托咪定、咪达唑仑用于妇科腹腔镜手术后患者自控芬太尼静脉镇痛液的效果

目的:比较右美托咪定、咪达唑仑用于妇科腹腔镜手术后患者自控芬太尼静脉镇痛(Patient-controlled analgesia,PCA)液中的效果。方法:150例妇科腹腔镜手术患者接受丙泊酚-芬太尼-罗库溴铵诱导、七氟烷麻醉维持后随机分为5组,每组30例。O组加入 16 mg 恩丹司琼,M组加入 5 mg 咪达唑仑,OM组加入 16 mg 恩丹司琼及 5 mg 咪达唑仑,D组加入 200 μg 右美托咪定,OD组加入 16 mg 恩丹司琼及 200 μg 右美托咪定。PCA按 20 μg/mL 芬太尼计算共计 60 mL,背景输注 1 mL/h,bolus 0.5 mL,锁定时间 15 min。记录麻醉后恢复室(PACU)、术后 6 h 及 24 h 的术后恶心呕吐(Postoperative nausea and vomiting,PONV)发生率、镇静评分、VAS评分、芬太尼使用量及PCA有效按压次数、止吐及镇痛补救措施人数。结果:O组术后3个时间段PONV发生率明显高于其他4组,但术后 6 h 及 24 h 时点的镇静评分明显低于其他4组(P<0.05);D组及OD组术后3个时间段PONV发生率明显低于M组(P<0.05)。O组补救止吐药使用30人次(100%),明显多于其他4组(P<0.05),D组及OD组补救止吐药使用次数明显少于其他3组(P<0.05)。5组患者术后3个时间段的VAS评分差异无统计学意义(P>0.05),但D组及OD组术后6、24 h 的芬太尼PCA使用量及有效按压次数明显少于M组、OM组及O组(P<0.05)。结论:右美托咪定、咪达唑仑加入芬太尼PCA镇痛液中,止吐效果优于恩丹司琼,但两药均有一定的镇静作用,右美托咪定辅助镇痛、镇吐效果更优。

Effects of dexmedetomidine or midazolam given in patient-controlled intravenous analgesic fentanyl solution in gynecological laparoscopic surgery

AIM: To compare the clinical effects of dexmedetomidine or midazolam given in patient-controlled intravenous analgesic fentanyl solution in gynecological laparoscopic surgery.METHODS: 150 patients undergoing gynecological laparoscopic surgery, received propofol-fentanyl-rocuronium anesthesia induction and conventional sevoflurane for maintain anesthesia, were randomly assigned into five groups with 30 cases each. A dose of 16 mg ondansetron was added to PCA in group O, 5 mg midazolam was added to PCA in group M, 16 mg ondansetron and 5 mg midazolam were added to PCA in group OM, 200 μg dexmedetomidine was added to PCA in group D, while 16 mg ondansetron and 200 μg dexmedetomidine was added to PCA in group OD. PCA using 20 μg/mL of fentanyl was started in all groups postoperatively. Total volume of PCA was 60 mL, and was programmed to deliver 1 mL/h of continuous doses and a 0.5 mL bolus on demand, with a 15 minutes lockout interval. The incidence of postoperative nausea and vomiting (PONV), sedation score, visual analog scale (VAS) for pain, cumulative fentanyl dose, PCA effective pressing times and rescue drug dose for PONV or pain were investigated at the postanesthesia care unit (PACU), 6 h and 24 h after operation.RESULTS: The incidence of PONV was significantly higher in group O at three time periods than those in other four groups(P<0.05), but the sedation score was significantly lower at 6 h and 24 h postoperation than in other four groups(P<0.05). The incidence of PONV was significantly lower in group D and OD at three time periods than in group M(P<0.05). 24 cases (80%) used antiemetics in group O and was significantly more than other four groups(P<0.05). The frequency of used antiemetic in group D and OD were significantly less than other three groups(P<0.05). There were no significant difference of VAS scale at three time periods in five groups, cumulative fentanyl dose and PCA effective pressing times were significantly less in group D and OD than other three groups(P<0.05).CONCLUSION: Dexmedetomidine or midazolam given in PCA fentanyl solution proved more effective than ondansetron in preventing PONV but with some sedation. Dexmedetomidine given auxiliary analgesic and antiemetic effects was better.