黄理进 张婵娟 吕夏 利鸿胜 陈海林

[摘要]目的探討右美托咪定对宫颈癌根治术患者术后疼痛和认知功能的影响。方法选择2018年1月至2021年2月在茂名市人民医院行腹腔镜下宫颈癌根治手术的患者94例。按照随机数字表法将患者分为对照组（ n=47）及观察组（ n=47）。对照组术后使用舒芬太尼+甲磺酸托烷司琼镇痛，观察组术后使用舒芬太尼+甲磺酸托烷司琼+右美托咪定镇痛。对比两组手术相关指标（术中失血量、补液量、阿托品使用量、麻黄碱使用量），两组术后不同时间（术后1 h、术后6 h、术后12 h、术后24 h、术后48 h）的疼痛情况（VAS 评分）、镇静情况（Ramesay评分）、认知功能情况（MMSE 评分），术后不良反应发生情况。结果两组术中失血量、补液量、阿托品使用量、麻黄碱使用量比较，差异无统计学意义（ P >0.05）。观察组术后1、6、12、24、48 h 的 VAS 评分低于对照组（ P <0.05）。观察组术后1、6、12、24、48 h 的Ramesay评分、MMSE 评分高于对照组（ P <0.05）。两组术后不良反应总发生率比较，差异无统计学意义（ P >0.05）。结论对于行宫颈癌根治术的患者，在术后常规镇痛的基础上给予适量的右美托咪定，有助于改善患者术后疼痛及镇静情况，改善患者术后认知功能，用药安全性较好。

[关键词]右美托咪定;宫颈癌;疼痛;认知功能;腹腔镜

[中图分类号] R737.3 [文献标识码] A  [文章编号]2095-0616（2021）22-0096-05

Effects of dexmedetomidine on postoperative pain and cognitive function in patients with cervical cancer undergoing radical hysterectomy

HUANG  Lijin   ZHANG  Chanjuan   LV  Xia   LI  Hongsheng   CHEN  Hailin

Department of Anesthesiology， Maoming People's Hospital， Guangdong， Maoming 525000， China

[Abstract] Objective To explore the effects of dexmedetomidine on postoperative pain and cognitive function of patients with cervical cancer （CC） undergoing radical hysterectomy. Methods A total of 94 CC patients underwent laparoscopic radical hysterectomy in Maoming People's Hospital from January 2018 to February 2021 were selected as the research subjects. According to the method of random numbers， the patients were divided into the control group （n=47） and the observation group （n=47）. The control group received sufentanil and tropisetron mesylate for postoperative analgesia， while the observation group received sufentanil， tropisetron mesylate and dexmedetomidine for postoperative analgesia. The two groups were compared in terms of operation-related indexes （bleeding volume， fluid infusion volume， atropine consumption and ephedrine consumption during operation）， Visual Analogue Scale （VAS）， Ramesay sedation score and cognitive function （mini-mental state examination， MMSE） at different times （1 h， 6 h， 12 h， 24 h and 48 h after operation）， and occurrence of adverse reactions after surgery. Results There were no significant differences in bleeding volume， fluid infusion volume， atropine consumption and ephedrine consumption during operation between the two groups （P >0.05）. The VAS scores of the observation group at 1 h， 6 h， 12 h， 24 h and 48 h after operation were lower than those of the control group （P <0.05）. Ramesay scores and MMSE scores of the observation group at 1 h， 6 h， 12 h， 24 h and 48 h after operation were higher than those of the control group （P <0.05）. There was no significant difference in the incidence of postoperative adverse reactions between the two groups （P >0.05）. Conclusion CC patients undergoing radical hysterectomy should be given proper dosage of dexmedetomidine on the basis of conventional postoperative analgesia， which is helpful to improve postoperative pain and sedation， improve postoperative cognitive function， and it has sound medication safety.

[Key words] Dexmedetomidine; Cervical cancer; Pain; Cognitive function; Laparoscope

宫颈癌是一种对女性健康构成严重威胁的恶性肿瘤[1]，近些年，宫颈癌疫苗问世，但未对整体防控工作产生明显影响[2-3]。目前在我国以及全球范围内，宫颈癌的人群发病率仍然处于较高水平[4-6]。围绕宫颈癌手术的相关研究也一直是全球医疗界关注的热点问题[7]。目前采用腹腔镜完成宫颈癌手术属于主流术式，该操作方法创伤程度低，术后恢复快，治疗效果明确[8-9]。在临……