目的 观察右旋美托咪啶用于腹腔镜胆囊切除术后自控镇痛(PCA)的安全性与效能.方法 选择行腹腔镜胆囊切除手术患者60例,按随机数字表法分为右旋美托咪啶组(D组,n=30)和芬太尼组(F组,n=30).记录2组术前,术后1、3、6、12、24、36和48 h的MBP、HR、RR、SpO2;观察并记录术后1、3、6、12、24、36和48 h镇痛效果[视觉模拟评分法(VAS)评分]、镇静评分、按压PCA键次数以及镇痛期间的不良反应.结果 2组患者MBP、RR、SpO2各时间点相比较差异无统计学意义(均P＞0.05);F组患者HR各时间点相比较差异无统计学意义(P＞0.05),D组患者术后HR各时间点较基础值及F组明显降低(P＜0.05);2组患者的VAS评分和镇静评分比较差异均无统计学意义(均P＞0.05);2组患者按压PCA键次数及镇静过度、呼吸抑制、恶心呕吐发生率比较差异无统计学意义(P＞0.05);D组心动过缓发生率较F组明显升高(P＜0.01).结论 右旋美托咪啶可以安全有效地应用于腹腔镜胆囊切除术后PCA.%Objective To evaluate the safety and potency of dexmedetomidine (Dex) for patient-controlled analgesia (PCA) after laparoscopic cholecystectomy.Methods Sixty patients who underwent laparoscopic cholecystectomy were randomly assigned to receive either Dex (D group, 30 patients) or fentanyl (F group, 30 patients) for postoperative PCA.MBP, HR, RR and SpO2 were measured before and 1,3,6,12,24,36 and 48 hours after laparoscopic cholecystectomy.PCA pressing frequency and adverse effects were observed,and visulal analogue scale(VAS)scores and sedation scores were estimated.Results There were no significant differences in MBP,RR and SpO2 between D group and F group before and after laparoscopic cholecystectomy ( P＞0.05).Postoperative HR was lower than preoperatively in D group(P＜0.05), but no differences in HR were observed among different time points in F group(P＞0.05).Compared with D group,the postoperative HR increased and the incidence of bradycardia decreased in F group(P＜0.05 or P＜0.01).There were no differences in the incidence of excessive sedation, respiratory depression,nausea and vomiting between the two groups(P＞0.05).Conclusion Dex is safe and effective for PCA after laparoscopic cholecystectomy.
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