目的 观察亚临床剂量右美托咪定预防腹腔镜下子宫肌瘤切除术后恶心呕吐的效果。方法 选择2016-06至2017-12在上海市长宁区妇幼保健院择期行腹腔镜下子宫肌瘤切除手术的患者120例,随机分为:右美托咪定组、雷莫司琼组、甲氧氯普胺组3组,每组40例。右美托咪定组诱导前输注右美托咪定,背景剂量0.4 μg/kg,缓慢输注完毕(3~5 min),并以0.25 μg/(kg·h)术中维持至拔管;雷莫司琼组手术结束前30 min给予雷莫司琼静推0.3 mg;甲氧氯普胺组手术结束前30 min给予甲氧氯普胺20 mg。观察3组拔管后0~1 h、＞1~3 h、＞3~6 h、＞6~12 h内发生恶心、呕吐的情况。结果 术后3 h内3组发生恶心呕吐的概率比较,差异无统计学意义,术后3 h后右美托咪定组和雷莫司琼组患者术后恶心和呕吐发生率明显低于甲氧氯普胺组,差异有统计学意义(P<0.05),且右美托咪定组和雷莫司琼组之间差异无统计学意义。结论 诱导前静脉注射一定剂量的右美托咪定并术中小剂量维持输注或手术结束前30 min给予一定剂量的雷莫司琼、甲氧氯普胺,在术后3 h内预防腹腔镜下子宫肌瘤切除术后的恶心、呕吐发生率相同,3 h后使用右美托咪定和雷莫司琼的效果优于甲氧氯普胺,且前两者的效果相同。
Abstract
Objective To study the effect of subclinical doses of dexmedetomidine on the prevention of nausea and vomiting after laparoscopic myomectomy.Methods One hundred and twenty patients scheduled to undergo laparoscopic myomectomy between June 2016 and December 2017 were selected. These patients were randomly divided into three groups: the dexmedetomidine group, the ramosetron group , and the metoclopramide group. In the dexmedetomidine group, the background dose was 0.4 μg/kg, and infusion was completed slowly (3-5 min). The ramosetron group was given remerstom 0.3 mg 30 min before the end of the operation. The metoclopramide group was given metoclopramide 20 mg 30 min before the end of surgery. The incidence of nausea and vomiting was observed in these three groups of patients 0-1 h, ＞1-3 h, ＞3-6 h, ＞6-12 h after extubation.Results There was no statistically significant difference in the incidence of postoperative nausea and vomiting between the three groups 3 h after surgery, but the incidence of postoperative nausea and vomiting in the dexmedetomidine group and the ramosetron group was significantly lower than that in the metoclopramide group (P<0.05).Conclusions Intravenous injection of some dose of dexmedetomidine before induction and intraoperative maintenance of small-dose infusion or a dose of ramosetron or metoclopramide (wintin 3 hour) 30 min before the end of surgery can all effectively prevent nausea and vomiting induced by laparoscopic hysteromyoma resection three hours after surgery. Dexmedetomidine and ramosetron are more effective than metoclopramide.
关键词
右美托咪定 /
子宫切除术 /
恶心呕吐
Key words
dexmedetomidine /
resection of the hysterectomy /
nausea and vomiting
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