右旋美托咪啶联合氢吗啡酮用于高原地区妇科开腹手术后自控静脉镇痛的效果及安全性的研究 #br#

目的 探讨右旋美托咪啶联合氢吗啡酮用于高原地区妇科开腹手术后患者自控静脉镇痛（PCIA）的效果 和不良反应。方法 根据随机数字表法将160例全麻下行妇科开腹手术术后使用PCIA的高原地区患者分为4组：右旋美托咪啶2 μg/kg+舒芬太尼1 μg/kg组（DS组）；右旋美托咪啶2 μg/kg+氢吗啡酮0.03 mg/kg组（DH1组）；右旋美托 咪啶2 μg/kg+氢吗啡酮0.05 mg/kg组（DH2组）；右旋美托咪啶2 μg/kg+氢吗啡酮0.1 mg/kg组（DH3组）。比较各组患 者术后 48 h 内多个时点的视觉模拟评分（VAS）、自控镇痛次数、补充镇痛次数、呕吐等不良反应的发生率。结果 DS组、DH2组和DH3组在各时点的静息痛和运动痛VAS评分、自控镇痛次数差异无统计学意义。DH1组各时点静 息痛和运动痛VAS评分、自控镇痛次数较其他各组明显增加（P＜0.05），且只有DH1组需要补充镇痛。DH3组的呕 吐发生率显著高于其他各组（P＜0.05）。结论 右旋美托咪啶2 μg/kg联合氢吗啡酮0.05 mg/kg用于高原地区妇科开 腹手术后PCIA疗效显著且不良反应发生率低，推荐为高原地区妇科开腹手术后PCIA使用剂量。

Study on the analgesic effect and safety of dexmedetomidine combined with hydromorphone for patient-controlled intravenous analgesia (PCIA) after gynecological open surgery in plateau area

Objective To explore the analgesic effect and side effects of dexmedetomidine combined with hydromorphone for patient-controlled intravenous analgesia (PCIA) after gynecological open surgery in plateau area. Methods According to the random number table method, 160 patients in plateau area who received PCIA after gynecological open surgery under general anesthesia were divided into 4 groups: dexmedetomidine 2 μg/kg + sufentanil 1 μg/kg group (DS group), dexmedetomidine 2 μg/kg + hydromorphone 0.03 mg/kg group (DH1 group), dexmedetomidine 2 μg/kg + hydromorphone 0.05 mg/kg group (DH2 group) and dexmedetomidine 2 μg/kg + hydromorphone 0.1 mg/kg group (DH3 group). The visual analogue scale (VAS), the number of self-controlled analgesia and the number of supplementary analgesia in 48 hours were compared to evaluate the analgesic effect between the four groups. The incidence of adverse reactions such as vomiting was also compared between the four groups. Results There were no significant differences in VAS scores of resting pain, motor pain and the frequency of self-control analgesia at each time point between DS group, DH2 group and DH3 group. The VAS scores of resting pain, motor pain and the frequency of self-control analgesia at each time point were significantly higher in DH1 group than those in other groups (P＜0.05). Only the patients in DH1 group needed additional analgesia. The incidence of vomiting was significantly higher in DH3 group than that in other groups (P＜0.05). Conclusion Dexmedetomidine 2 μg/kg combined with hydromorphone 0.05 mg/kg has a significant effect on PCIA after gynecological open surgery in plateau area and has a low incidence of adverse reactions, so it is recommended as the best dose of PCIA after gynecological open surgery in plateau area.