在接受妇科腹腔镜手术的患者中，将右美托咪定加入吗啡类镇痛可减少术后早期恶心：一项随机对照试验。
Adding dexmedetomidine to morphine-based analgesia reduces early postoperative nausea in patients undergoing gynecological laparoscopic surgery: a randomized controlled trial.
机构信息
Department of Anesthesiology, Peking University First Hospital, Beijing, China.
Department of Anesthesiology, Beijing Shangdi Hospital, Beijing, China.
出版信息
BMC Anesthesiol. 2020 Jan 8;20(1):11. doi: 10.1186/s12871-019-0928-y.
BACKGROUND
Few studies have investigated the effect of dexmedetomidine on postoperative nausea and vomiting (PONV) in patients underwent gynecological laparoscopic surgery. We investigated if adding dexmedetomidine to a morphine-based patient-controlled analgesia (PCA) could decrease the incidence of PONV in this high-risk patient population.
METHODS
In this prospective, randomized, double-blind and placebo-controlled study, 122 patients underwent gynecological laparoscopic surgery were assigned into two groups. Patients in the dexmedetomidine group (Group Dex) received a loading dose of dexmedetomidine 0.4 μg/kg before the end of surgery, followed by morphine 0.5 mg/ml plus dexmedetomidine 1 μg/ml for postoperative i.v. PCA. Patients in the control group (Group Ctrl) received normal saline before the end of surgery, followed by morphine 0.5 mg/ml alone for postoperative i.v. PCA. PCA pump was programmed as followed: bolus dose 2 ml, lockout interval 8 min and background infusion at a rate of 1 ml/h. The primary outcome was the incidence of nausea and vomiting within the first postoperative 24 h.
RESULTS
Although there were no significant differences in regard to the total incidence of PONV (41.0% vs 52.5%, P = 0.204), PONV score, time to first onset of PONV, or the need for rescue antiemetics within the first postoperative 24 h between the two groups, the incidence of nausea and total PONV during the first 2 h period was significantly lower in the Group Dex than in the Group Ctrl (9.8% vs 24.6%, P = 0.031 and 0.031, respectively). More patients in Group Dex were over sedated or had bradycardia during the PACU compared with Group Ctrl (P = 0.040 and 0.036, respectively).
CONCLUSION
Our protocol in which dexmedetomidine was administered postoperatively - after a loading dose - to intravenous PCA morphine in patients undergoing gynecological laparoscopic surgery, had only early antiemetic effects, while no clinically meaningful antiemetic effect could be evidenced within the first 24 h after surgery.
TRIAL REGISTRATION
Current control trial registered at Chictr.org.cn: ChiCTR1800017172. Date registered: 07/16/2018.
背景
很少有研究调查右美托咪定对妇科腹腔镜手术后恶心和呕吐（PONV）的影响。我们研究了在这种高风险患者人群中，将右美托咪定加入吗啡为基础的患者自控镇痛（PCA）是否可以降低 PONV 的发生率。
方法
在这项前瞻性、随机、双盲和安慰剂对照研究中，122 名接受妇科腹腔镜手术的患者被分为两组。右美托咪定组（Dex 组）在手术结束前给予右美托咪定负荷剂量 0.4μg/kg，然后给予吗啡 0.5mg/ml 加右美托咪定 1μg/ml 用于术后静脉 PCA。对照组（Ctrl 组）在手术结束前给予生理盐水，然后单独给予吗啡 0.5mg/ml 用于术后静脉 PCA。PCA 泵编程如下：推注剂量 2ml，锁定间隔 8min，背景输注速度为 1ml/h。主要结局是术后 24 小时内恶心和呕吐的发生率。
结果
尽管两组间 PONV 的总发生率（41.0%比 52.5%，P=0.204）、PONV 评分、首次发生 PONV 的时间或术后 24 小时内需要解救性止吐药无显著差异，但 Dex 组在术后 2 小时内恶心和总 PONV 的发生率明显低于 Ctrl 组（9.8%比 24.6%，P=0.031 和 0.031，分别）。与 Ctrl 组相比，Dex 组在 PACU 期间更多的患者出现过度镇静或心动过缓（P=0.040 和 0.036，分别）。
结论
我们的方案是在妇科腹腔镜手术后静脉给予负荷剂量右美托咪定，然后给予吗啡 PCA，该方案仅具有早期止吐作用，而在术后 24 小时内没有明显的临床意义的止吐作用。
试验注册
本对照试验已在 Chictr.org.cn 注册，注册号：ChiCTR1800017172。注册日期：2018 年 7 月 16 日。
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