右美托咪定用于腹腔镜胆囊切除术中的临床观察

目的 探讨右美托咪定用于腹腔镜胆囊切除术中的安全性和有效性.方法 ASA Ⅰ或Ⅱ级择期行腹腔镜胆囊切除术的患者32例,随机均分为右美托咪定组(D组)和生理盐水对照组(C组).D组和C组于气管插管后手术开始前10 min分别静脉泵注右美托咪定0.6μg/kg和生理盐水(泵注时间为10 min).两组均以吸入异氟醚维持麻醉.观察记录患者入室及切皮和拔管时的血压、心率以及术中维持麻醉时异氟醚的肺泡气浓度和拔除气管导管的时间.结果 与入室时比较,切皮时和拔管时C组血压明显升高和心率明显增快(P＜0.05),D组血压,心率无明显变化.D组术后烦躁的发生率显著低于C组(P＜0.05).结论 右美托咪定可使腹腔镜胆囊切除术患者的血流动力学更稳定,术后苏醒迅速而完全.     

右美托咪定预防术后恶心呕吐的研究进展

背景 术后恶心呕吐(postoperative nausea and vomiting,PONV)发生率为20％～80％,右美托咪定(dexmedetomidine,Dex)是一种新型的高选择性α2肾上腺素受体激动剂,近来研究提示,Dex可能在预防和治疗PONV中发挥作用.目的 了解Dex预防和治疗PONV的效果.内容 综合相关文献,从Dex防治PONV的机制、优势、最佳剂量、应用时间、给药途径等方面探讨其防治PONV的效果.趋向 Dex有望成为减少PONV发生的一种新的药物选择.     

右美托咪定不同给药方法用于腹腔镜胆囊切除术患者麻醉中的临床观察

目的 探讨右美托咪定(dexmedetomidine,DEX)不同给药方法在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者麻醉中辅助镇静的安全性和可行性. 方法 100例LC患者按随机数字表法分为4组:DEX负荷剂量组(Dd组)、持续剂量组(Dc组)、负荷剂量加持续输注剂量组(Ddc组)和对照组(C组),每组25例.通过不同的给药方法观察DEX对围术期循环、呼吸指标、及苏醒和术后镇痛的影响. 结果 Dd组、Dc组患者在清醒时间及拔管时间较C组、Ddc组明显缩短,清醒时间:(8.4±2.7)、(8.4±4.3)、(11.4±5.5)、(11.2±4.5) min (P＜0.05);拔管时间:(11.1±3.4)、(10.7±4.1)、(14.1±5.4)、(14.2±6.2) min(P＜0.05);应用DEX的3组术后2h视觉模拟评分法(visual analogue scales,VAS)评分明显低于C组(1.2±0.9)、(1.6±0.8)、(1.8±0.7)、(2.5±1.3)(P＜0.05);Dd组、Dc组和Ddc组在应用DEX后血压和心率(heart rate,HR)明显降低(P＜0.05),与C组比较也明显下降(P＜0.05),但4组患者围术期循环参数均在正常范围内;Dd组、Dc组和Ddc组在麻醉维持中应用的镇痛、镇静药物的总量与C组比较明显减少(P＜0.05). 结论 应用负荷剂量、持续剂量及负荷剂量加持续剂量输注的DEX均可用于LC麻醉中的辅助镇静,既稳定循环又苏醒迅速,负荷剂量及持续剂量输注的方法更优于负荷加持续输注的方法,但仍需大样本研究加以证实.     

右美托咪啶对腹腔镜胆囊切除术全麻效果的影响

目的 探讨预先注射小剂量右美托咪啶( dexmedetomidine,Dex)对腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者全麻效果的影响.方法 择期行LC患者50例,ASA Ⅰ ～Ⅱ级,年龄21岁～57岁,体重42.5 kg～80 kg,按随机数字表法分为生理盐水组(C组)和...     

右美托咪定复合帕瑞昔布钠对腹腔镜胆囊切除术后疼痛的影响

目的观察右美托咪定复合帕瑞昔布钠对腹腔镜胆囊切除术后疼痛的影响。方法择期腹腔镜胆囊切除手术患者45例,随机均分为三组:右美托咪定复合帕瑞昔布钠组(DP组)、帕瑞昔布钠组(P组)和对照组(C组)。术前30min DP组静注右美托咪定0.5μg/kg和帕瑞昔布钠20mg;P组静注帕瑞昔布钠40mg;C组静注5ml生理盐水。监测并记录入室时、插管即刻、气腹5min、气腹30min、拔管即刻的MAP和HR,记录丙泊酚和瑞芬太尼用量、苏醒时间、拔管时间、恶心、呕吐发生率和患者满意度。并记录术后2h(T1)、6h(T2)、12h(T3)、24h(T4)静态、动态(剧烈咳嗽或突然翻身时)疼痛数字等级评分(numerical rating scale,NRS)和Ramsay镇静评分。结果入室时、插管即刻、气腹5min、气腹30min、拔管即刻时三组患者MAP、HR差异无统计学意义。三组患者丙泊酚、瑞芬太尼用量、苏醒时间和拔管时间差异均无统计学意义。与C组比较,T1~T3时DP组和P组静态NRS评分明显降低(P0.05);T1~T4时DP组和T1、T2时P组动态NRS评分明显降低(P0.05)。与DP组比较,T1、T2时P组和C组Ramsay镇静评分明显降低(P0.05)。DP组2例需用阿托品,1例需用麻黄碱;P组1例需用阿托品,1例患者麻黄碱;C组2例NRS评分≥7分,肌注盐酸布桂嗪100mg后NRS评分≤5分,1例需用阿托品,2例需用麻黄碱。与DP组比较,P组和C组满意度明显降低(P0.05)。三组患者恶心、呕吐发生率差异无统计学意义。结论术前30min静注帕瑞昔布钠20mg复合0.5μg/kg右美托咪定减轻腹腔镜胆囊切除术后急性疼痛,效果优于单用帕瑞昔布钠。     

预防腹腔镜胆囊切除术后恶心呕吐的临床研究

目的　比较格拉司琼联合地塞米松及小剂量氟哌啶与单独应用格拉司琼对 L C术后 PONV的预防作用。方法　 86例 L C手术、女性病人 ,随机分为格拉司琼联合用药组、格拉司琼组及对照组 :观察术后 2 4 h内的恶心、呕吐发生率及副反应。结果　格拉司琼组及联合用药组术后 2 h内 PONV均显著低于对照组 (P<0 .0 5和 P<0 .0 1) ,联合用药组术后 2～ 12 hPONV显著低于对照组 (P<0 .0 1) ,术后 12～ 2 4 h PONV显著低于对照组 (P<0 .0 1)及格拉司琼组 (P<0 .0 5 )。结论　格拉司琼与地塞米松、氟哌啶联合用药预防 L C术后恶心呕吐的发生 ,疗效优于单用格拉司琼 ,没有明显的副作用 ,值得临床使用     

预注不同负荷剂量右美托咪定在腹腔镜胆囊切除术中的应用

目的 比较麻醉诱导前预注不同负荷剂量右美托咪定在腹腔镜胆囊切除术中的应用效果。
方法 选择2019年12月至2020年12月择期全麻下行腹腔镜胆囊切除术的患者120例,男52例,女68例,年龄18～64岁,BMI 20～35 kg/m²,ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为四组：生理盐水组（C组）、右美托咪定0.5 μg/kg组（L组）、右美托咪定0.75 μg/kg组（M组）和右美托咪定1.0 μg/kg组（H组）,每组30例。C组麻醉诱导前10 min恒速静脉泵注生理盐水0.5 ml/kg,L组、M组和H组麻醉诱导前10 min分别恒速静脉泵注右美托咪定0.5、0.75和1.0 μg/kg。所有患者为全凭静脉麻醉,麻醉用药相同。记录输注生理盐水/右美托咪定前即刻（T₁）、麻醉诱导前即刻（T₂）、气管插管后即刻（T₃）、手术切皮即刻（T₄）、气腹开始即刻（T₅）、气腹后10 min（T₆）、缝合完毕即刻（T₇）、气管拔管后即刻（T₈）的HR和MAP。记录术中丙泊酚、瑞芬太尼用量、阿托品使用例数、苏醒时间、拔管时间、术后1、4 h咳嗽时VAS疼痛评分。记录苏醒期躁动、术后心动过缓、术后低血压、术后48 h内恶心呕吐等不良反应发生情况。
结果 与C组比较,L组、M组和H组T₂—T₈时HR明显减慢（P<0.05）,T₃—T₈时MAP明显降低（P<0.05）,术中丙泊酚和瑞芬太尼用量明显减少（P<0.05）,术后1、4 h咳嗽时VAS疼痛评分明显降低（P<0.05）,苏醒期躁动、术后恶心呕吐发生率明显降低（P<0.05）;M组苏醒时间、拔管时间明显缩短（P<0.05）;H组阿托品使用率明显升高（P<0.05）,苏醒时间、拔管时间明显延长（P<0.05）,术后心动过缓和低血压发生率明显升高（P<0.05）。与L组比较,H组T₂—T₆时HR明显减慢（P<0.05）,M组和H组术后1、4 h咳嗽时VAS疼痛评分明显降低（P<0.05）。
结论 腹腔镜胆囊切除术全麻诱导前预注右美托咪定0.75 μg/kg可以有效维持围术期血流动力学稳定,减少麻醉药物用量,缩短苏醒时间,减少术后并发症,有利于患者术后恢复。     

右美托咪定对全身麻醉下行腹腔镜胆囊切除术治疗胆囊疾病的老年患者的应激反应的影响

目的 探讨右美托咪定对全身麻醉下行腹腔镜胆囊切除术老年患者的应激反应的影响。方法 回顾性分析2021年1月至2022年2月南京医科大学附属江宁医院收治的全身麻醉下行腹腔镜胆囊切除术的老年患者70例的临床资料,根据麻醉干预方式不同分为对照组和研究组各35例,对照组患者采用丙泊酚干预,研究组患者采用盐酸右美托咪定注射液干预。比较两组患者麻醉诱导前(T₀)、气管插管时(T₁)、建立气腹时(T₂)、气管导管拔管时(T₃)、拔管5min后(T₄)血流动力学指标、应激指标以及手术情况。结果 研究组T₀～T₃时心率、平均动脉压均低于对照组(P <0.05),且两组T₄时血流动力学指标无显著差异(P> 0.05)。研究组T₀～T₃时血浆皮质醇水平均低于对照组(P <0.05),研究组T₄时,血管紧张素Ⅱ水平低于对照组(P <0.05),且两...     

托烷司琼预防腹腔镜胆囊切除术后病人恶心呕吐的效应

目的评价托烷司琼预防腹腔镜胆囊切除术后病人恶心呕吐的效应。方法择期腹腔镜下行胆囊切除术病人60例，ASAⅠ或Ⅱ级，随机分为对照组和托烷司琼组，每组30例。采用常规的麻醉诱导和维持。术毕托烷司琼组静脉注射托烷司琼2mg（用生理盐水稀释至5ml），对照组给予等量生理盐水。观察术毕～术后24h恶心、干呕和呕吐的发生率，并用评分法（0～10分）评估其程度，记录清醒程度评分及不良反应。结果与对照组相比，托烷司琼组术毕～术后3h恶心、干呕和呕吐发生率及其程度降低，头痛和烦燥发生率降低；术后3～24h干呕发生率及程度降低，恶心程度降低（P〈0．05）；清醒程度评分差异无统计学意义。结论托烷司琼可减少腹腔镜胆囊切除术病人恶心呕吐的发生及并降低其严重程度。     

右美托咪啶静脉复合麻醉在腹腔镜胆囊切除术的临床观察

目的：观察右美托咪啶复合瑞芬太尼行静脉麻醉用于腹腔镜胆囊切除术（Lc）的麻醉效果及术中知晓情况。方法：择期行Lc患者240例,随机分均为右美托咪啶组（D组）和丙泊酚组（P组）。D组给以右美托咪啶复合瑞芬太尼和顺阿曲库铵麻醉诱导和维持,P组则以丙泊酚复合瑞芬太尼和顺阿曲库铵行麻醉诱导和维持。记录麻醉诱导、插管及腹腔充气的心血管反应;记录术中用药、术后恢复情况以及患者的满意度。并调查术中知晓发生率。结果：D组患者的麻醉诱导和气管插管未见血压明显变化,腹腔充气血压升高（P〈0．01）,拔管后血压降低（P〈0．01）;P组患者麻醉诱导后血压降低（P〈0．01）。D组麻醉和手术过程心率降低（P〈0．01）而P组心率保持不变。P组清醒拔管时间均少于D组（P〈0．05）。D组阿托品和乌拉地尔的使用较多（P〈0．01）,麻黄碱使用较少（P〈0．05）。D组术后即时镇痛（P〈0．01）、恶心呕吐发生率少于P组（P〈0．05）。结论：右美托咪啶复合瑞芬太尼麻醉效果确切、安全,是腹腔镜胆囊切除术麻醉选择方法之一,术中注意右美托咪啶诱导给药速度、加强心率监护和管理,且无术中知晓发生。     

Comparison of dexamethasone,metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

Background Postoperative nausea and vomiting (PONV) are one of the most common complaints following anesthesia and surgery. This study was designed to evaluate the efficacy of dexamethasone, metoclopramide, and their combination to prevent PONV in patients undergoing laparoscopic cholecystectomy. Methods A total of 160 ASA physical status I and II patients were included in this randomized, double blind, placebo-controlled study. Patients were randomly assigned to 4 groups (n = 40 each): group 1 consisting of control patients administered 0.9% NaCl; group 2 patients received metoclopramide 10 mg just before the end of anesthesia; group 3 patients received dexamethasone 8 mg after the induction of anesthesia; and group 4 patients received dexamethasone 8 mg after the induction of anesthesia and metoclopramide 10 mg before the end of anesthesia. The incidence of PONV, mean visual analog pain scores at rest and on movement, time to the first request for analgesia, side effects, and well-being score were recorded during the first 24 h postoperatively. Results Data were analyzed using one-way analysis of variance (ANOVA) and the χ² test, with p < 0.05 considered statistically significant. The total incidence of PONV was 60% with placebo, 45% with metoclopramide, 23% with dexamethasone, and 13% with the combination of dexamethasone plus metoclopramide. None of the dexamethasone plus metoclopramide group patients (p < 0.05 versus groups 1 and 2) and one dexamethasone group patient (p < 0.05 versus group 1) required antiemetic rescue, as compared with four patients in the metoclopramide group and six patients in the placebo group. Pain scores, the time to the first request for analgesia, and side effects were similar across the study groups. Conclusions Dexamethasone and the combination of dexamethasone plus metoclopramide were more effective in preventing PONV than metoclopramide and placebo.     

几种药物预防腹腔镜胆囊切除术后恶心呕吐的对比研究

目的比较格拉司琼、氟哌利多、地塞米松单用或合用预防腹腔镜胆囊切除术后恶心呕吐的效果。方法择期腹腔镜胆囊切除术患者160例,于麻醉前随机分为四组,静脉注入各预防性药物,A组：地塞米松10mg;B组：氟哌利多2．5mg;C组：氟哌利多2．5mg＋地塞米松10mg;D组：格拉司琼3mg。观察术后24h恶心呕吐发生率。结果四组术后24h恶心呕吐总发生率分别为78％、63％、25％、28％,C组和D组明显低于A组和B组（P〈0．01）,而C组与D组差异无统计学意义。结论格拉司琼、氟哌利多、地塞米松都有预防腹腔镜胆囊切除术后恶心呕吐的作用,但以格拉司琼和氟哌利多＋地塞米松效果显著,而且氟哌利多＋地塞米松更显示其性价比优越性。     

星状神经节阻滞对腹腔镜全子宫切除术患者术后睡眠质量和恶心呕吐的影响

目的 观察超声引导下右侧星状神经节阻滞（SGB）对腹腔镜全子宫切除术患者术后睡眠质量和恶心呕吐（PONV）的影响。
方法 选择择期行腹腔镜全子宫切除术患者98例,年龄42～74岁,BMI 19～25 kg/m ²,ASAⅠ或Ⅱ级。采用随机数字表法分为两组：全身麻醉联合SGB组（S组）和全身麻醉组（GA组）,每组49例。S组于麻醉诱导前在超声引导下行右侧SGB,注入 0.2%罗哌卡因5 ml,GA组不行SGB。两组采用相同的全身麻醉方法和麻醉药物。记录术前1 d、手术当日、术后1 d的匹兹堡睡眠质量指数（PSQI）。记录术后24 h PONV分级和止吐药补救情况。记录术后24 h活动时VAS疼痛评分、镇痛药补救情况、术后首次下床活动时间和术后住院时间。记录局麻药中毒、全脊髓麻醉、气胸、臂丛神经阻滞等SGB相关并发症发生情况。
结果 与GA组比较,S组手术当日、术后1 d PSQI评分、POSD发生率明显降低（P＜0.05）,PONV 0级、1级发生率明显升高,PONV 2级、3级、4级发生率、止吐药补救率明显降低（P＜0.05）,术后24 h活动时VAS疼痛评分明显降低（P＜0.05）,术后首次下床活动时间明显缩短（P＜0.05）。两组补救镇痛情况、术后住院时间差异无统计学意义。S组无一例出现局麻药中毒、全脊髓麻醉、气胸、臂丛神经阻滞等SGB相关并发症。
结论 右侧星状神经节阻滞可有效改善腹腔镜全子宫切除术患者的术后睡眠质量,降低术后恶心呕吐的发生率及严重程度,减轻术后疼痛。     

How to study postoperative nausea and vomiting

Anesthesiological journals are flooded by innumerable studies of postoperative nausea and vomiting (PONV). Nevertheless, PONV remains a continuing problem with an average incidence of 20-30%. This paper should provide essential information for the design, conduct, and presentation of these studies. It should also increase comparability among future studies and help clinicians in assessing and reading the literature on PONV. First, future studies should address new and relevant questions instead of repeatedly investigating prophylactically given antiemetics whose main results are predictable (e.g. already proven by meta-analysis). Second, group comparability should be based on well-proven risk factors and a simplified risk score for predicting PONV. Endless listings of doubtful risk factors should be avoided. Third, a realistic sample size estimation should be performed, i.e. in most cases at least 100 patients per group are necessary. Fourth, nausea, vomiting and rescue medication should be recorded and reported separately with the corresponding incidences (and number of patients with these separate symptoms), and the main end-point should be PONV. The entire observation period should cover 24 h. Additional reporting of the early (0-2 h) and delayed (2-24 h) postoperative period is desirable and should consider single and cumulative incidences. Lastly, interpretation of results should take into account the study hypothesis, sources of potential bias or imprecision, and the difficulties associated with multiplicity of analysis and outcomes.     

Postoperative nausea and vomiting after bariatric surgery and dexmedetomidine anesthetic: a propensity-weighted analysis

BackgroundPatients undergoing laparoscopic bariatric surgery have high rates of postoperative nausea and vomiting (PONV). Dexmedetomidine based anesthetic could reduce PONV rates.ObjectivesTo determine if PONV rates differ in patients undergoing laparoscopic bariatric surgery with anesthesia primarily based on dexmedetomidine or standard anesthetic management with inhalational agents and opioids.SettingUniversity hospital.MethodsFrom January 2014 to April 2018, 487 patients underwent laparoscopic bariatric surgery and met inclusion criteria (dexmedetomidine, n = 174 and standard anesthetic, n = 313 patients). In both groups, patients received preoperative PONV prophylaxis. We analyzed rates of PONV and moderate-to-deep sedation. A propensity score was calculated and outcomes were assessed using generalized estimating equations with inverse probability of treatment weighting.ResultsPerioperative opioids and volatile anesthetics were reduced in dexmedetomidine patients. During anesthesia recovery the incidence of PONV was similar between dexmedetomidine and standard anesthetic patients (n = 37 [21.3%] versus n = 61 [19.5%], respectively; inverse probability of treatment weighting odds ratio = 1.35; 95% confidence interval .78–2.32, P = .281), and the incidence of sedation higher in dexmedetomidine patients (n = 86 [49.4%] versus n = 75 [24.0%]; inverse probability of treatment weighting odds ratio = 2.43; 95% confidence interval 1.47–4.03, P < 0.001). Rates of PONV and sedation were similar during the remainder of the hospital stay. A secondary sensitivity analysis was performed limited to dexmedetomidine patients who did not receive volatile and results were similar.ConclusionsWhile dexmedetomidine-based anesthesia was associated with reduced opioid and volatile agents use, it was not associated with a reduction of PONV. The higher rates of moderate-to-deep sedation during anesthesia recovery observed with dexmedetomidine may be undesirable in morbidly obese patients.     

妇科腹腔镜手术术后恶心呕吐的临床研究

目的 分析妇科腹腔镜手术术后恶心呕吐(PONV)的发生情况及其影响因素.方法 按前瞻性临床队列研究设计,应用单因素和多因素logistic回归分析围术期变量与术后PONV发生之间的关系.术后6 h及24 h内发生的恶心或呕吐为本研究的结局变量.结果 研究期间共有260例患者行妇科腹腔镜手术,最终有237例有效病例.其中术后6 h内有80例出现PONV,术后24 h内有94例发生PONV.多因素logistic回归分析提示妇科腹腔镜手术术后6 h及24 h PONV的危险因素为既往FONV史及术毕疼痛,而氟哌利多有助于减轻术后6 h内PONV.结论 妇科腹腔镜手术PONV,高发,尤以6 h内明显;既往PONV史及术毕疼痛可增加本次手术PONV发生的风险.     

胸腔内迷走神经阻滞对肺叶切除术患者术后恶心呕吐的影响

目的：通过观察胸腔内迷走神经阻滞对肺叶切除术患者术后恶心呕吐（PONV）的影响,验证胃肠-迷走神经-脑轴在肺叶切除术PONV中起到重要的作用。
方法：选择择期行胸腔镜下右侧肺叶切除术的女性患者180例,年龄30～75岁,BMI 18～30 kg/m²,ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：胸腔内迷走神经阻滞组（VB组）和对照组（C组）,每组90例。术中由外科医师在胸腔镜下对VB组使用0.75%罗哌卡因2.5 ml行气管下段右侧迷走神经阻滞,C组不行胸腔内迷走神经阻滞。记录肺叶切除术后24 h内PONV发生情况。记录术后24 h内首次肛门排气和排便情况、补救性止吐药应用情况、术后24 h 数字疼痛评分量表（NRS）评分、意识模糊评估法-中文修订版（CAM-CR）评分。记录术后24 h内咳嗽、低血压等不良反应发生情况。
结果：两组患者年龄、BMI、ASA分级、晕动症、PONV病史、高血压和糖尿病发生率差异无统计学意义。两组无一例吸烟、哮喘病史。与C组比较,术后24 h内VB组PONV发生率明显降低[24(27%) vs 39 (43%), （P<0.05）]。两组术后24 h内首次肛门排气和排便情况、补救性止吐药应用情况、术后24 h NRS评分、CAM-CR评分差异无统计学意义。两组术后24 h内无一例咳嗽、低血压等不良反应。
结论：肺叶切除术中胸腔内迷走神经阻滞能够有效减少PONV的发生,提示迷走传入神经在介导PONV的发生中起到重要的作用。