Abstract: Objective To explore the effect of intrathecal application of different doses of dexmedetomidine on postoperative analgesia during procedure for prolapse and hemorrhoids （PPH）. Methods 380 patients undergoing PPH under combined spinal and epidural anesthesia were selected and randomly divided into 4 groups： C group （intrathecal 0.5% ropivacaine 15 mg）, LDA group （intrathecal 0.5% ropivacaine 15 mg + dexmedetomidine 5 μg）, LDB group（intrathecal 0.5% ropivacaine 15 mg + dexmedetomidine 7.5 μg） and LDC group（intrathecal 0.5% ropivacaine 15 mg + dexmedetomidine 10 μg）, 95 cases in each group. Record the time when patients first used analgesics, spinal anesthesia analgesia time, and differential analgesia time after surgery, and the visual analog scale （visual analogue scale, VAS） score. Results The first postoperative analgesic time, spinal anesthesia analgesia time, and differential analgesia time in the LDA group, LDB group, and LDC group were all longer than those in the C group, and the differences were statistically significant （P<0.05）. The VAS scores of the LDA group, LDB group, and LDC group at rest and during activity at 6 h, 12 h, and 24 h after surgery and immediately after taking analgesics were lower than those in the C group, and the difference was statistically significant （P<0.05）. Conclusion Dexmedetomidine is an intrathecal safe and effective adjuvant, which can enhance the effect of postoperative analgesia and reduce the dosage and frequency of postoperative analgesics. It is an effective scheme to realize comfortable medical treatment after PPH,Intrathecal application of 7.5 μg dexmedetomidine can achieve more satisfactory differential analgesia time.

Key words: dexmedetomidine, intrathecal injection, PPH, comfortable medical care

摘要： 目的 探讨在痔疮行吻合器痔上黏膜环切术（PPH）中不同剂量右美托咪定鞘内应用对术后镇痛效果的影响。方法 选取在腰硬联合麻醉下行PPH的患者380例,随机分为4组：C组（鞘内0.5％罗哌卡因15 mg）、LDA组（鞘内0.5％罗哌卡因15 mg+右美托咪定5 μg）,LDB组（鞘内0.5％罗哌卡因15 mg+右美托咪定7.5 μg）和LDC组（鞘内0.5％罗哌卡因15 mg+右美托咪定10 μg）,每组95例。记录患者术后首次使用镇痛药时间、腰麻镇痛时间、差异性镇痛时间,术后6 h、12 h、24 h、使用镇痛药即刻在静息和活动时的视觉模拟评分法（VAS）评分。结果 LDA组、LDB组、LDC组术后首次使用镇痛药时间、腰麻镇痛时间、差异性镇痛时间均比C组延长,差异具有统计学意义（P<0.05）。LDA组、LDB组、LDC组术后6 h、12 h、24 h和使用镇痛药即刻在静息和活动时VAS评分均比C组低,差异具有统计学意义（P<0.05）。结论 右美托咪定是PPH术后舒适化医疗安全且有效的鞘内佐剂,可以增强术后镇痛效果并减少术后镇痛药的使用剂量和频率,是实现PPH术后舒适化医疗的有效方案,7.5 μg右美托咪定鞘内应用可获得更满意的差异性镇痛时间。

关键词: 右美托咪定, 鞘内注射, PPH, 舒适化医疗