The Effect Of Dexmedetomidine On Postoperative Nausea And Vomiting In Patients With Gynecologic Tumors

Objective:In this study,the intravenous infusion of dexmedetomidine before anesthesia induction and postoperative dexmedetomidine combined with sufentanil for controlled intravenous analgesia were used were used to investigate the efficacy of dexmedetomidine on postoperative nausea and vomiting in gynecological tumor patients,and to provide evidence for postoperative drug use in gynecological patients.Methods:Eighty patients with gynecologic tumor radical surgery under general anesthesia were selected in our hospital.ASAI-II grade,age 20-60 years old,weight 50-65kg,patients were divided into 2 groups by random number table,experimental group?D Group,n=40?,control group?group C,n=40?;group D received dexmedetomidine intravenously at a dose of 1.0?g/kg 10 min before intubation,while group C received an equal dose of physiology.The saline was replaced,and the patient in group D was given a dose of 100?g sufentanil in combination with 120?g dexmedetomidine and diluted with physiological saline to 100 ml.The group C was treated with 100?g of sulphate alone.The fentanyl complex saline was diluted to100 ml with a pump.The two groups of patients did not use any drugs before entering the operating room,and both groups of patients were admitted to the operating room,under the local anesthesia,the right internal jugular vein catheterization,the open central venous access,and inject the liquid according to the principle of 4,2,1 rehydration,and the ratio of crystal solution?combined sodium chloride solution?and colloidal solution?hydroxyethyl starch 130/0.4 sodium chloride injection?according to the principle of 2:1.Observe and recorded the preoperative complications,duration of anesthesia,intraoperative fluid volume,intraoperative urine volume,remifentanil use and other anesthetic doses in the two groups.Meanwhile,heart rate?HR?and mean arterial pressure?MAP?at 10min?T₀?before intubation,immediately?T₁?,30min?T₂?during intubation,at the end of surgery?T₃?,6h?T₄?after surgery,and 24h?T₅?after surgery were continuously monitored in the two groups.At the same time,the levels of cortisol,serotonin,norepinephrine,adrenaline,dopamine and gastrin in plasma of the two groups were recorded at 10min?T0?before intubation,30min?T2?during surgery,at the end of surgery?T₃?,6h?T₄?after surgery,and 24h?T₅?after surgery.Adjust the depth of anesthesia according to the changes of intraoperative hemodynamics,and maintain the BIS value between 45-60,while maintaining blood pressure,heart rate changes not less than 20%of the baseline value,when the patient's intraoperative HR is less than 50 times/time-sharing,atropine 0.3-0.5mg,and ephedrine symptomatic treatment of blood pressure fluctuations;record and analysis of postoperative VAS score,PONV score,RSS score and total postoperative sufentanil consumption,Patient satisfaction after surgery.Results:1.There were no statistically significant differences between the two groups in age,weight,ASA classification,operative time,intraoperative fluid volume,intraoperative urine volume and other general data?P>0.05?.The doses of remifentanil in the D and C groups were?0.26±0.01?mg and?0.35±0.02?mg,respectively.The dose of remifentanil in group D was significantly reduced,and the difference was statistically significant.?P<0.05?.2.Hemodynamics comparison:There were no significant statistical differences in HR and MAP at each time point in the group compared with T0?P>0.05?.T₁-T₅mean HR of patients in group D were 65.18±3.47,72.39±4.00,73.15±3.01,71.21±3.42,72.06±3.14?times/min?,lower than that in group C?70.63±4.89,77.16±3.64,77.58±3.22,76.95±3.21,75.58±2.76,times/min?,and the difference was statistically significant?P<0.05?.Compared with MAP,the average MAP of patients in group D at T₁-T₃ was?73.56±3.15?mmHg,?82.94±2.49?mmHg,?83.76±3.10?mmHg,and the average MAP of patients in group C at T₁?75.68±3.43?mmHg,T₂?89.74±2.40?mmHg,and T₃?88.05±3.42?mmHg,respectively.The difference was statistically significant?P<0.05?.However,the intraoperative HR of patients in the C and D groups was not lower than 50 times/min,and the fluctuation range of MAP was within 20%of the basic value,and the variation rates of HR and MAP in the C and D groups were not statistically different?P>0.05?.3.Comparison of postoperative VAS scores:Patients in group D had a VAS score of 1h?2.58±0.70?and 6h?2.26±0.65?at rest after operation,and 1h?3.53±0.61?and 6h?3.89±0.81?VAS scores at rest after operation in group C.The ratio was significantly lower,and the difference was statistically significant?P<0.05?.The VAS scores of patients in group D at 24h?2.42±0.61?and 48h?2.32±0.58?after exercise,there were significantly lower than those in group C at 24h?3.37±0.16?and48h?3.53±0.12?after exercise,and the difference was statistically significant?P<0.05?.but the VAS scores at rest at 24h and 48h after operation and 1h and 6h after exercise,there was no statistical difference between the two groups?P>0.05?.4.Comparison of the sufentanil consumption after operation:The total consumption of sufentanil at 6h,24h and 48h after operation in group D was?25.79±1.78??g,?40.74±3.12??g,?49.00±2.50??g,and 6h after operation in group C?29.63±2.83??g,24h?46.68±2.60??g,48h?59.37±2.77??g of sufentanil consumption was significantly reduced,and the difference was statistically significant?P<0.05?.5.Comparison of postoperative RSS scores:the RSS scores of patients in group D at 1h,6h,24h and 48h after surgery were 2.68±0.68,2.47±0.56,2.32±0.47,2.18±0.39,respectively,Compared with patients in group C at 1h,6h,24h and48h?3.32±0.81,3.88±0.77,3.62±0.99,3.38±1.02,respectively?after surgery,the RSS scores of patients in group D were significantly lower,and the difference was statistically significant?P<0.05?.6.There was no significant difference in the concentrations of 5-HT,norepinephrine,adrenaline,dopamine,cortisol and gastrin in the D and C groups at each time point?P>0.05?.The plasma concentrations of epinephrine,norepinephrine,cortisol,gastrin,5-HT and dopamine in group D were significantly lower than those in group C at T₂-T₅,and the difference was statistically significant?P<0.05?.7.The incidence of postoperative severe nausea and vomiting was 2.9%in group D and 5.35%in group C,respectively.The incidence of postoperative nausea and vomiting in group C was significantly higher than that in group D,and the difference was statistically significant?P<0.05?.8.Postoperative satisfaction of patients in group D and C was significantly higher than that in group C?29.4%?,and the difference was statistically significant?P<0.05?.Conclusion:Compared with sufentanil alone after surgery,dexmedetomidine?1.0?g/kg?and dexmedetomidine?120?g?combined with sufentanil?100?g?intravenously10 min before anesthesia induction Self-controlled analgesia for gynecologic tumor surgery patients can significantly reduce the amount of opioids?such as sufentanil?required for postoperative analgesia;effectively reduce the VAS score during postoperative rest and exercise.The RSS score within 24 hours after surgery has an advantage of analgesia and sedation;it significantly reduces the levels of plasma epinephrine,norepinephrine,cortisol and other neurotransmitters during and 24hours after surgery,effectively inhibiting Intraoperative and postoperative stress levels;significantly reduced the incidence of postoperative nausea and vomiting,and improved postoperative satisfaction.