佟春廷　李青　殷志春

【摘要】 目的：评价右美托咪定用于腹腔镜胆囊手术后镇痛（PCIA）的临床效果。方法：选择笔者所在医院2016年1月-2018年6月80例择期在全身麻醉下行腹腔镜胆囊手术患者，ASA分级Ⅰ～Ⅱ级，随机分为A、B两组，每组40例。A组镇痛用药为：布托啡诺10 mg+格拉司琼3 mg；B组镇痛用药在A组的基础上加右美托咪定200 ?g。患者术后2 h、6 h、12 h、24 h、48 h的VAS评分和Ramsay镇静评分被观察和记录；记录术后镇痛期间不良反应发生情况和镇痛泵总按压次數，镇痛结束后评价患者对镇痛的满意度。结果：比较两组患者镇痛、镇静期间VAS评分、Ramsay镇静评分，差异无统计学意义（P>0.05）。镇痛泵按压次数：A组高于B组，差异有统计学意义（P<0.05）。恶心、呕吐和眩晕发生率B组明显较低，差异有统计学意义（P<0.05）。48 h镇痛期间两组患者均未使用其他镇痛药物；B组总体满意度明显高于A组，差异有统计学意义（P<0.05）。结论：右美托咪啶用于腹腔镜胆囊手术患者术后PCIA镇痛，临床镇痛、镇静效果确切，降低单独使用布托啡诺PCIA镇痛、镇静不良反应的发生率，布托啡诺使用量减小，患者的满意度得到明显提高。

【关键词】 右美托咪定； 布托啡诺； 患者自控静脉镇痛； 胆囊手术

doi：10.14033/j.cnki.cfmr.2018.24.006 文献标识码 B 文章编号 1674-6805（2018）24-00-03

The Clinic Effect of Dexmedetomidine Combined with Butorphanol on PCIA after Laparoscopic Gallbladder Surgery/TONG Chunting，LI Qing，YIN Zhichun.//Chinese and Foreign Medical Research，2018，16（24）：-15

【Abstract】 Objective：To evaluation the clinical effect of Dexmedetomidine for PCIA after laparoscopic cholecystectomy.Method：80 patients undergoing laparoscopic gallbladder surgery under general anesthesia from January 2016 to December 2017 in the authors hospital were randomly divided into group A and group B according to the random number table method（40 in each），ASA Grade Ⅰ-Ⅱ Grade.The patients in the group A received Butorphanol 10 mg+Granisetron 3 mg；in the group B received Butorphanol 10 mg+Granisetron 3 mg+Dexmedetomidine 200 ?g.Result：The VAS scores and Ramsay sedation scores were compared between two groups at each time point，the difference was not statistically significant（P>0.05）.The number of analgesic pump presses in both groups during the 48 h analgesia：the total number of presses in group B was significantly less than group A，the differences were statistically significant（P<0.05）.The incidence of nausea，vomiting and dizziness was significantly lower in group B than in group A（P<0.05）.No analgesia was needed for the two groups of patients during analgesia for 48 hours.The overall satisfaction of group B on postoperative analgesia was significantly higher than that of group A（P<0.05）.Conclusion：The clinical efficacy of Dexmedetomidine combined with Butorphanol in patients undergoing laparoscopic gallbladder surgery with self-controlled intravenous analgesia is clear.The incidence of adverse reactions of butorphanol alone can be reduced，the use of butorphanol is reduced， and patient satisfaction is significantly improved，

【Key words】 Dexmedetomidine； Butorphanol； Patient-controled intravenous analgesia； Gallbladder surgery

First-authors address：The Peoples Hospital of Jinhu，Jinhu 211600，China

术后疼痛刺激对机体多系统产生不良反应，如给患者带来心理负担，处于紧张状态，影响神经内分泌功能、凝血功能、胃肠功能等延缓患者术后康复，而良好的术后镇痛能控制患者的应急反应，促进患者康复[1-3]。本文通过对比研究腹腔镜胆囊手术后48 h内单用布托啡诺与右美托米啶联合布托啡诺的临床镇静、镇痛效果和不良反应发生率，发现联合用药能减少单独使用布托啡诺的不良反应，同时患者对镇痛的总体满意度提高[4-5]，现报告如下。

1 资料与方法

1.1 一般资料

选择笔者所在医院2016年1月-2017年12月80例择期在全身麻醉下行腹腔镜胆囊手术患者，其中，男47例，女33例，年龄28～73岁，体重51～83 kg，身高156～178 cm，ASA分级Ⅰ～Ⅱ级，所有患者均使用PCA镇痛装置行术后镇痛，术前进行培训，使患者对VAS疼痛评分和Ramsay镇静评分能有所认识。无……