右美托咪定复合布托啡诺对妇科腹腔镜手术患者术后镇痛的效果观察

目的：观察右美托咪定复合布托啡诺用于妇科腹腔镜手术后患者静脉自控镇痛（ PCIA）的安全性和有效性。方法择期全身麻醉下行妇科腹腔镜手术的患者80例，经患者知情同意，按照数字表法随机分为2组，每组40例。右美托咪定复合布托啡诺组（ DB组）患者麻醉诱导后，静脉泵注右美托咪定0．5μg／kg，对照组泵注等量生理盐水。2组患者手术结束前15 min均给予布托啡诺1．0 mg。术后行自控静脉镇痛（PCIA）：对照组使用布托啡诺0．125 mg／kg（最大剂量不超过10 mg）， DB组在使用布托啡诺基础上加入右美托咪定0．1μg／（kg· h）（最大剂量不超过300μg）。观察并记录术后1、2、6、12、24 h患者疼痛视觉模拟（ VAS）评分和镇静评分、24 h内镇痛泵按压次数、追加镇痛药次数、不良反应以及患者的总体满意度。结果DB组患者术后1、2、6、12、24 h静息和活动时VAS评分均显著低于对照组，差异有统计学意义（ P＜0．05）；DB组患者镇痛泵按压次数少于对照组，布托啡诺用量明显降低，差异有统计学意义（P＜0．05）。与对照组比较，DB组患者恶心呕吐、眩晕发生率显著降低，差异有统计学意义（P＜0．05），对术后镇痛的总体满意度较高，差异有统计学意义（P＜0．05）；2组患者均未发生心动过缓、呼吸抑制等不良反应。结论右美托咪定可增强布托啡诺对妇科腔镜手术患者术后镇痛效果，减少布托啡诺消耗量，降低不良反应发生率，提高患者满意度。

Effects of dexmedetomidine combined with butorphanol on the analgesia of the patients after gynecological laparoscopic surgery

Objective To observe the safety and efficacy of dexmedetomidine combined with butorphanol in patients with in-travenous analgesia after gynecological laparoscopic surgery.Methods Eighty patients who underwent gynecological laparoscopic sur-gery by general anesthesia were randomly divided into 2 groups, each consisting of 40 patients.With the anesthesic induction of dexme-detomidine and butorphanol, the patients in the dexmedetomidine combined with butorphanol group ( or the DB group) further received 0.5μg/kg dexmedetomidine by intravenous pumping, while the patients in the control group received the same volume of normal saline. Fifteen minutes before the end of surgery, the patients in both groups received 1.0 mg butorphanol.Patient-controlled intravenous anal-gesia(PCIA)was implemented after surgery.The patients in the control group received 0.125 mg/kg butorphanol with the highest dos-age not exceeding 10 mg, while the patients in the DB group were given butorphanol plus 0.1 μg/kg.h dexmedetomidine, with the highest dosage not exceeding 300μg.VAS and analgesia scores were observed at h 1, 2, 6,12 and 24 after surgery.The total number of button pressing of PCIA within 24 hours was observed, the number of supplementary analgesic agents was recorded, and adverse drug reactions and total rate of patient satisfaction were evaluated statistically.Results VAS scores at rest and exercise at h 1, 2, 6, 12 and 24 for the patients of the DB group were all significantly lower than those of the control group after surgery, with statistical significance ( P<0.05) .The total number of button pressing of PCIA for the patients of the DB group was less than that of the control group, and butorphanol consumption of the DB group was also significantly lower, also with statistical significance (P<0.05) .As compared with the control group, the rates of nausea and vomiting, dizziness for the patients of the DB group were all significantly lower, and statistical significance could be noted when comparisons were made between the 2 groups (P<0.05).Total rate of satisfaction with analgesia was considerably high after surgery, with statistical significance (P<0.05).Adverse drug reactions, such as bradycardia and respiratory inhibition did not occur in the patients of both groups.Conclusion Dexmedetomidine could enhance the analgesic effect of butorphanol after gynecological laparoscopic surgery, reduce the consumption of the butorphanol and decrease adverse drug reactions, and most im-portantly increase the rate of patients′satisfaction.