| Background:According to the latest statistical data of the American Cancer Society in 2022,lung cancer is the malignant tumor with the highest incidence rate,the highest mortality rate for men(22%),and the second highest mortality rate for women(17%).Currently,thoracoscopic radical lung cancer surgery has become the standard surgical method for lung cancer in the National Comprehensive Cancer Network(NCCN)and The American College of Chest Physicians(ACCP)lung cancer treatment guidelines.Although thoracoscopic surgery has advantages such as minimal trauma and fast recovery compared to traditional thoracotomy,the incidence of postoperative nausea and vomiting is still relatively high.Since the use of general anesthesia in the 1840 s,it has been found that postoperative nausea and vomiting(PONV)is one of the common complications after general anesthesia surgery.PONV as an unpleasant experience,disturbs 20-30% of patients undergoing general anesthesia surgery,and the incidence rate of PONV can be as high as 80% for patients with high risk factors without preventive measures.PONV can reduce patient comfort and satisfaction,and in rare cases may lead to adverse consequences such as dehydration and electrolyte disorders,aspiration of gastric contents,esophageal rupture,bleeding and dehiscence at the wound site.There are many factors that can cause PONV,which can be roughly divided into three aspects: patient factors,anesthesia factors,and surgical factors.Women are the most specific predictor of PONV(Odd Ratio,OR 4.89),and their risk of developing PONV is 2.6times higher than men;The incidence of PONV varies among different populations,with adults being the high-risk group,while the incidence of PONV in elderly patients has significantly decreased.At present,clinical measures for preventing and treating PONV include drug therapy and non drug therapy.Small doses of glucocorticoids and 5-HT3 receptor antagonists are commonly used in drug therapy,while non drug therapy measures such as acupoint stimulation and hydration therapy are still high in female patients,and further in-depth research is needed.Dexmedetomidine(Dex)is a highly selective drug α2 Adrenergic receptor agonist,which has analgesic effect,anti anxiety effect,sympathetic nerve block,organ protection effect and sedative effect similar to natural sleep,has been continuously focused on the role of Dex in preventing PONV in many studies.Previous studies have shown that the use of Dex in female patients(gynecological endoscopic surgery,breast cancer radical surgery,etc.)can reduce the risk of postoperative nausea and vomiting,However,for female patients undergoing thoracoscopic radical resection of lung cancer,the impact of Dex on PONV remains unclear,and further research is needed on its appropriate dosage.Objective:Exploring the effect of dexmedetomidine on postoperative nausea and vomiting in female patients undergoing thoracoscopic radical lung cancer surgery,as well as the appropriate dosage of dexmedetomidine for the prevention and treatment of postoperative nausea and vomiting,in order to provide reference for the prevention and treatment of postoperative nausea and vomiting in such patients in clinical practice.Method:136 adult female patients undergoing elective thoracoscopic radical lung cancer surgery were randomly divided into four groups using a random number table: Dex1 group,with dexmedetomidine 0.2μg/kg/h given after induction until 30 minutes before the end of surgery;Dex2 group,administered with0.4μg/kg/h dexmedetomidine after induction until 30 minutes before the end of surgery;Dex3 group,administered with 0.8μg/kg/h dexmedetomidine after induction until 30 minutes before the end of surgery;Group C and control group were given the same dose of physiological saline after induction until 30 minutes before the end of the surgery.The four groups used the same anesthesia induction,anesthesia maintenance,and postoperative analgesia plan.Indicator collection: General preoperative and intraoperative data of patients,incidence of PONV within 48 hours after surgery(T1: PACU retention period;T2: PACU exit 12h;T3: postoperative 12h-postoperative 24h;T4: postoperative 24-postoperative48h),PONV grading in four time periods(T1-T4)within 48 hours after surgery,incidence of postoperative vomiting(POV)in four time periods(T1-T4)within 48 hours after surgery,POV score in four time periods(T1-T4)within 48 hours after surgery Visual pain simulation(VAS)score,intraoperative use of vasoactive drugs,Ramsay sedation score during patient recovery period,recovery room stay time,PCA press frequency within 48 hours,sleep quality score within 48 hours,use of remedial analgesics,use of remedial antiemetics,time for first postoperative recovery of drinking water,time for first postoperative recovery of eating,time for first postoperative ambulation,time for first postoperative recovery of bed activity 15QOR-15 scores and postoperative pulmonary complications.Results:There was a statistically significant difference in the incidence of PONV among the four groups of patients at T2(15.62% vs 9.68% vs 25.80% vs 43.33%,2=12.388,p=0.006).The incidence of PONV in the Dex1 and Dex2 groups was lower than that in the C group,and the difference was statistically significant(p<0.05);There was a statistically significant difference in the incidence of PONV among the four groups of patients during T3(62.50% vs 29.03% vs 48.39% vs 63.33%,2=9.587,p=0.022).The incidence of PONV in the Dex2 group was lower than that in the Dex1 and C groups,and the difference was statistically significant(p<0.05);There was a statistically significant difference in the incidence of POV among the four groups of patients during T3(28.13% vs 9.68% vs 12.90% vs 43.33%,2=12.216,p=0.006).The incidence of POV in the Dex2 and Dex3 groups was lower than that in the C group,and the difference was statistically significant(p<0.05).The dosage of remifentanil in the four groups was statistically significant(14.49± 4.17μ g/kg vs11.45±4.46μg/kg vs 11.28±3.86μg/kg vs 14.70±3.92μg/kg,F=6.133,p=0.001);The dosage of remifentanil in Dex1 group and C group was higher than that in Dex2 group(p<0.05),and the dosage of remifentanil in Dex1 group and C group was higher than that in Dex3 group(p<0.05).There was a statistically significant difference in the dosage of the vasoactive drug norepinephrine among the four groups during surgery [0(0,0)mg vs 0(0,0)mg vs 0(0,0.075)mg vs 0(0,0)mg,Z=11.029,p=0.012];The intraoperative dosage of norepinephrine in Dex3 group was higher than that in C group(p<0.05)There was a statistically significant difference in the residence time of the four recovery rooms(90.66± 24.74 minutes vs 104.03 ± 31.74 minutes vs 115.96 ± 27.81 minutes vs 98.47 ± 22.20 minutes,F=4.763,p=0.004).The residence time of the Dex3 group was significantly higher than that of the Dex1 and C groups,with a statistically significant difference(p<0.05).There was a statistically significant difference in pain scores among the four groups of patients at T2(2.84 ± 0.75 vs 2.10 ± 0.93 vs 2.23 ± 1.31 vs 2.93 ± 0.77,F=5.314,p=0.002).The VAS scores of the Dex2 and Dex3 groups were lower than those of the C group,and the difference was statistically significant(p<0.05).There was a statistically significant difference in pain scores among the four groups of patients during T4(1.22 ± 0.41 vs 1.13 ± 0.55 vs 1.23 ± 0.61 vs 1.57 ± 0.67,F=3.373,p=0.021).The VAS score of Dex2 group was lower than that of C group,and the difference was statistically significant(p<0.05).There was a statistically significant difference in the number of PCA compressions within 48 hours after surgery among the four groups of patients(3.88 ± 2.82 times vs 2.10 ± 1.47 times vs 1.81 ± 1.22 times vs 4.00 ±2.72 times,F=8.051,p<0.05).The number of PCA compressions within 48 hours between the Dex2 and Dex3 groups was lower than that between the C and Dex1 groups,and the difference was statistically significant(p<0.05).There was a statistically significant difference in the first postoperative recovery time among the four groups of patients(16.34 ± 2.89 h vs 12.39 ± 3.10 h vs 17.13 ± 4.32 h vs 17.80 ± 3.93 h,F=13.541,p<0.05).The first postoperative water intake time in the Dex2 group was shorter than that in the Dex1,Dex3,and C groups(p<0.05).The regression model shows that the Dex2 group(intraoperative pump infusion 0.4 μg/kg/h)is a protective factor for PONV,and the difference is statistically significant(p<0.05);The higher preoperative anxiety and depression score,the amount of remifentanil used during the operation,and the history of motion sickness were the risk factors for PONV,and the difference was statistically significant(p<0.05).Conclusion:For adult female patients undergoing thoracoscopic radical resection of lung cancer,intravenous infusion of dexmedetomidine during general anesthesia can reduce the incidence of postoperative nausea and vomiting,reduce perioperative opioid consumption,improve postoperative analgesic effect,and shorten postoperative feeding time,especially during surgery 0.4 μ g/kg/h is more suitable for promoting early postoperative recovery in patients. |
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