观察右美托咪定滴鼻用于腹腔镜胆囊切除术后镇痛的有效性和安全性。

选择2021年10月至2022年1月于邛崃市医疗中心医院收治并择期行全身麻醉下腹腔镜胆囊切除术的患者64例，其中男性17例，女性47例；年龄18~65岁，平均(44.03±10.97)岁；体重指数(BMI)<35kg/m²；美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组，试验组(D组，31例)于术毕清醒拔除喉罩后给予右美托咪定2 μg/kg滴鼻，对照组(C组，33例)于术毕清醒拔除喉罩后给予等容量0.9%等渗盐水滴鼻。记录两组患者一般情况及术中情况；记录术后2、8、12、24 h静息和运动时视觉模拟评分(visual analogue scale，VAS)；记录术后24 h内补救镇痛的例数以及初次补救镇痛的间隔时间；记录术后24 h内恶心、呕吐的发生例数及严重程度；记录24 h内最满意镇痛且最轻呕吐(satisfactory analgesia with minimal emesis，SAME)的达标比例；记录术后24 h内严重心动过缓、呼吸抑制、循环不稳、镇静过度等不良反应的发生情况。

与C组比较，D组2、8 h静息和运动VAS评分及12 h运动VAS评分明显降低(P<0.05)，两组术后补救镇痛的次数差异无统计学意义(P>0.05)，但D组初次补救镇痛的间隔时间明显延长(P<0.05)。与C组比较，D组术后恶心呕吐的发生率及严重程度明显降低(P<0.05)。D组SAME达标率明显高于C组(P<0.05)。两组患者术后均未出现严重心动过缓、呼吸抑制(SPO₂低于95%)、循环不稳(需要药物干预)、镇静过度等不良反应。

腹腔镜胆囊切除术后右美托咪定2 μg/kg滴鼻能在不辅助其他术后镇痛药的情况下，改善患者术后疼痛及恶心呕吐，延长初次补救镇痛的间隔时间，且无明显不良反应。

To observe the efficacy and safety of intranasal dexmedetomidine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy.

A total of 64 patients admitted to Medical Center Hospital of Qionglai City undergoing laparoscopic cholecystectomy, 17 males and 47 females, aged 18~65 years, the average age of 44.03±10.97 years, BMI<35 kg/m², ASA physical status Ⅰ or Ⅱ, were randomly divided into 2 groups according to the random number table method: test group (group D, n=31) and control group (group C, n=33). Group D was given dexmedetomidine 2 μg/kg intranasally after the laryngeal mask was removed at the end of operation. The equal volume of normal saline was given instead of dexmedetomidine in group C. The general and intraoperative conditions of the two groups of patients were recorded. The VAS pain score at rest and during exercise (turning over, getting out of bed, etc.) were recorded at 2, 8, 12 and 24 h after the operation. The number of cases of rescue analgesia within 24 hours after operation and the time of initial rescue analgesia were recorded. The number and severity of nausea and vomiting within 24 hours after operation were recorded. The proportion of satisfactory analgesia with minimal emesis(SAME) within 24 hours was recorded. The occurrence of adverse reactions such as severe bradycardia, respiratory depression, circulatory instability, and excessive sedation within 24 hours after surgery were also recorded.

Compared with group C, the 2, 8 h rest and exercise VAS scores and 12h exercise VAS score of group D were significantly lower (P<0.05), and there was no significant difference in the frequency of postoperative rescue analgesia in group D (P>0.05), but the time of rescue analgesia was significantly prolonged (P<0.05). Compared with group C, the incidence and severity of postoperative nausea and vomiting in group D were significantly lower (P<0.05). The proportion of satisfactory analgesia with minimal emesis within 24 hours in group D was significantly higher than that in group C (P<0.05). There were no adverse reactions such as severe bradycardia, respiratory depression(SPO₂ lower than 95%), circulatory instability(requiring drug intervention), and excessive sedation in both groups after surgery.

Dexmedetomidine 2 tion in both groups after surgery. amprove postoperative pain, nausea and vomiting in patients with laparoscopic cholecystectomy without adjuvant other postoperative analgesics, prolong the painful interval time of initial rescue analgesia, and there are no obvious adverse reactions.