右美托咪啶对腹腔镜胃癌根治术后曲马多自控静脉镇痛质量的影响

目的：观察右美托咪啶对腹腔镜胃癌根治术后曲马多自控静脉镇痛（PCIA）质量的影响.方法：择期腹腔镜胃癌根治术患者60例,随机分为观察组和对照组,每组30例,采用静吸复合全麻.两组术后均使用电子微量泵静脉镇痛,泵内含曲马多800mg和托烷司琼5 mg,观察组加用右美托咪啶200 μg,观察麻醉开始前（T0）、术后2 h（T1）、4 h（T2）、8 h（T3）、12 h（T4）、24 h（T5）的平均动脉压（MAP）、心率（HR）、呼吸次数（RR）和脉搏氧饱和度（SpO2）及T1～T5时点的VAS,记录术后24 h内曲马多用量、PCIA按压次数、术后哌替啶使用例数及心动过缓、低血压、低氧血症、镇静过度、恶心、呕吐等不良反应.结果：观察组T1～T4时点MAP、HR和VAS低于对照组（P＜0.05）;对照组T1～T4时点MAP、HR高于T0和T5 （P＜0.05）;观察组术后24 h内曲马多用量、PCIA按压次数及哌替啶使用例数少于对照组（P＜0.05）,恶心发生率低于对照组（P＜0.05）.结论：右美托咪啶可提高腹腔镜胃癌根治术后曲马多PCIA的镇痛效果,减少曲马多用量,降低恶心的发生率.

Influence of dexmedetomidine on analgesic quality of patient controlled intravenous analgesia with tramadol after laparoscopy assisted radical gastrectomy

AIM：To observe the influence of dexmedetomidine on analgesic quality of patient controlled intravenous analgesia with tramadol after laparoscopy assisted radical gastrectomy.METHODS：Sixty patients scheduled to undergo laparoscopy assisted radical gastrectomy were randomly assigned to two groups （observation and control group） with 30 each.All patients were given general anesthesia and PCIA with tramadol 800 mg and tropisetron 5 mg.Dexmedetomidine 200 μg was added to PCIA in observation group.MAP,HR,RR,SpO2 was determined before anesthesia （T0） and at 2 hours （T1）,4 hours（T2）,8 hours（T3）,12 hours （T4） and 24 hours（T5） after operation.Postoperative pain was assessed by visual analogue score（VAS） at T1-T5.The total dose of tramadol and pressure times of PCIA within 24 hours after operation,cases of using pethidine,bradycardia,hypotension,hypoxemia,excessive sedation,nausea,vomiting were also recorded.RESULTS：Compared with the control group,the MAP,HR,VAS were lower at T1--T4 in observation group （P 〈 0.05）.MAP,HR were higher at T1-T4 than those at T0,T5 in control group （P 〈 0.05）.Compared with control group,the total dose of tramadol,pressure times of PCIA,cases of using pethidine and incident of nausea were less than those in observation group（P〈0.05）.CONCLUSION：Dexmedetomidine can improve the quality of PCIA with tramadol,decrease the dose of tramadol and reduce the incident of nausea after laparoscopy assisted radical gastrectomy.