目的 探讨右旋美托咪啶用于腹腔镜胆囊切除术后静脉自控镇痛(PCIA)的安全性与效能.方法 将60例行腹腔镜胆囊切除术患者按随机数字表法分为2组:右旋美托咪啶组(D组)和芬太尼组(F组),每组30例.D组行腹腔镜胆囊切除术后采用右旋美托咪啶自控镇痛治疗,F组行腹腔镜胆囊切除术后采用芬太尼自控镇痛治疗.观察2组患者术前,术后各时间点(术后1、3、6、12、24、36、48 h )SBP、DBP、心率(HR)、R、动脉血氧饱和度(SpO2)的变化及术后镇痛期间PCIA按键次数和不良反应等情况.对术后各时间点的2组患者进行镇痛(VAS疼痛评分)及镇静评分.结果 2组患者术前,术后各时间点SBP、DBP、R、SpO2值比较差异均无统计学意义(均P＞0.05),D组患者术后各时间点HR值较术前及F组明显降低(P＜0.05),F组患者术后各时间点VAS疼痛、镇静评分值与D组比较差异均无统计学意义(均P＞0.05),D组术后镇痛期间心动过缓发生率较F组高(P＜0.01).结论 右旋美托咪啶可安全、有效地应用于腹腔镜胆囊切除术后PCIA.%Objective To evaluate the safety and potency of dexmedetomidine for patient-controlled intravenous analgesia (PCIA) after laparoscopic cholecystectomy. Methods Sixty patients who underwent laparoscopic cholecystectomy were randomly assigned to receive either dexmedetomidine (D group, 30 patients) or fentanyl (F group, 30 patients) for postoperative PCIA.SBP, DBP, HR, R and SpO2 were measured before and 1,3,6,12,24,36 and 48 hours after laparoscopic cholecystectomy. PCIA pressing frequency and adverse effects were observed, and VAS pain scores and sedation scores were estimated. Results There were no significant differences in SBP,DBP,R and SpO2 between D group and F group before and after laparoscopic cholecystectomy(all P＞0.05). In D group, postoperative HR was lower than preoperatively(P＜0. 05). Compared with D group,postoperative HR increased and the incidence of bradycardia during analgesia decreased in F group(P＜0.05 or P＜0. 01). There were no differences in VAS pain scores and sedation scores between the two groups(both P＞0.05). Conclusion Dexmedetomidine is safe and effective for PCIA after laparoscopic cholecystectomy.
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