Objective: To investigate the effect of dexmedetomidine alone for postoperative analgesia after laparoscopic cholecystectomy. Methods: Forty patients scheduled for elective laparoscopic cholecystectomy in First Hospital of Ninghai County, American Society of Anesthesiologists (ASA) gradeⅠor Ⅱ, were randomly divided into dexmedetomidine group (Group D, n=20) and fentanyl group (Group F, n=20). The patient controlled analgesia (PCA) pumps were used after the operation. In the group D, the intravenous PCA protocol was dexmedetomidine 0.2 μg·kg(-1)·h(-1) diluted to 100 ml in 0.9% saline. In the group F, the PCA protocol was fentanyl 20 μg /kg diluted to 100 ml in 0.9% saline. Mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before induction of anaesthesia, end of operation and 4, 6, 8, 24, 48 hours after the operation. The pain score on a visual analogue scale (VAS) and the Ramsay sedation score were recorded at 4, 6, 8, 24, 48 hours after the operation. The incidences of postoperative nausea and vomiting (PONV), respiratory depression, dizziness, time to recovery of gastrointestinal function (time to first passage of flatus) and satisfaction with pain control were also recorded. Results: There were no significant difference in the general data of patients, duration of surgery, total dose of intraoperative propofol, fentanyl and sevoflurane, and total fluids during the operation (P>0.05). No patients received rescue analgesic. The MAP and HR values at different time points showed no significant difference between the groups (P>0.05). Similarly, the VAS scores and Ramsay sedation scale at 4, 6, 8, 24, 48 hours after the operation were not significantly different between the groups (P>0.05). The incidence of PONV was significantly reduced in group D, rating as 5%, comparing with 40% in Group F (P<0.05). Patients of Group D experienced a faster gastrointestinal function recovery, and the time to the first passage of flatus were (41.3±10.1) h in Group D and (55.6±11.4) h in Group F (t=-4.195, P<0.05), respectively. The pain treatment satisfactory score (PTSS) in Group D was (8.1±1.3) points, higher than that in Group F (6.1±1.5) points (t=4.426, P<0.05). Meanwhile, there was no statistic difference in the incidence of respiratory depression and dizziness in both groups (P>0.05). Conclusion: Intravenous infusion of dexmedetomidine alone at 0.2 μg·kg(-1)·h(-1) after laparoscopic cholecystectomy not only reduces postoperative pain, but also enhances satisfaction with pain control and improves the recovery of gastrointestinal function.
目的： 观察右美托咪啶单独用于腹腔镜胆囊切除手术术后镇痛的效果。 方法： 选择浙江省宁海县第一医院择期行腹腔镜胆囊切除手术的患者40例，美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级，采用抽签法随机分为2组(n＝20)：右美托咪啶组(D组)和芬太尼组(F组)，分别于手术结束后接静脉镇痛泵，D组配方为右美托咪啶0.2 μg·kg(－1)·h(－1)用0.9%生理盐水稀释到100 ml，F组配方为芬太尼20 μg/kg用0.9%生理盐水稀释到100 ml。观察2组患者麻醉诱导前，术毕，术后4、6、8、24和48 h的平均动脉血压(MAP)和心率(HR)，以及术后4、6、8、24和48 h的视觉模拟量表(VAS)疼痛评分和Ramsay镇静评分，并记录患者术后恶心呕吐的发生率、患者肠道功能的恢复时间和疼痛控制满意度评分。 结果： 2组患者一般资料、手术时间及术中异丙酚、芬太尼、七氟烷和总入量的比较差异均无统计学意义(均P>0.05)。2组患者均未接受补救镇痛，麻醉诱导前，术毕，术后4、6、8、24和48 h的MAP和HR，以及术后4、6、8、24和48 h的VAS疼痛评分和Ramsay镇静评分差异均无统计学意义(均P>0.05)。D组患者术后恶心呕吐的发生率为5%，与F组的40%相比，明显减少，差异有统计学意义(P<0.05)。D组患者术后肠道功能恢复(第一次肛门排气)时间为(41.3±10.1)h，与F组的(55.6±11.4 )h相比，显著缩短，差异有统计学意义(t＝－4.195，P<0.05)。D组患者疼痛控制满意度评分(PTSS)为(8.1±1.3 )分，与F组的(6.1±1.5 )分相比，明显增高，差异有统计学意义(t＝4.426，P<0.05)。2组患者呼吸抑制和头晕的发生率比较差异均无统计学意义(均P>0.05)。 结论： 静脉输注0.2 μg·kg(－1)·h(－1)右美托咪啶单独用于腹腔镜胆囊切除手术术后镇痛，不仅能减少术后疼痛，缩短肠道功能恢复时间，而且能提高患者术后疼痛控制满意度，促进患者早日康复。.
Keywords: Analgesia; Cholecystectomy, laparoscopic; Dexmedetomidine; Postoperative period.