Effect Of Different Doses Of Dexmedetomidine Combined With Fentanyl For Postoperative Analgesia After Gynecologic Laparotomy

Objective: To investigate the effect of different doses of dexmedetomidine combined with fentanyl on postoperative analgesia,hemodynamics and side effects in gynecological laparotomy.Methods: A total of 120 patients(ASA I-II grade,age(18-65years)who underwent open gynecological surgery and received postoperative patient-controlled intravenous analgesia from March 2016 to March 2017 were collected.They were randomly divided into four groups: control group(group C)-fentanyl(20ug/kg)+ tropisetron 10mg;low dose dexmedetomidine group(LD group)-fentanyl(20ug/kg)+ dexmedetomidine(2ug/kg)+tropisetron 10mg;middle dose dexmedetomidine group(MD group)-fentanyl(20ug/kg)+dexmedetomidine(3ug/kg)+ tropisetron 10 mg.High-dose dexmedetomidine group(HD group)--fentanyl(20ug/kg)+ dexmedetomidine(4ug/kg)+ tropisetron 10 mg.The age,weight and operation time of the patients were recorded.The blood pressure and heart rate at2,4,8,24 and 48 hours after operation,rest and activity pain,times of pressing,satisfaction,nausea and vomiting,respiratory depression and skin pruritus were also recorded.Results: There was no significant difference in age,weight,operation time and the amount of analgesics used during operation between the four groups(all P > 0.05).The resting and active VAS scores of the control group were significantly higher than those of the LD,MD and HD groups at 2h,4h,8h,24 h and 48 h after operation(p < 0.05);the resting and active VAS scores of the LD group at 2h,4h,8h,24 h and 48 h after operation were significantly higher than those of the MD group and HD group at 2h,4h,8h,24 h and48h after operation(p < 0.05);however,there was no significant difference between the rest and active VAS scores of the other groups at 2h,4h,8h,24 h and 48 h after operation.Learning significance(P > 0.05).The mean arterial pressure in control group,LD group and HD group was significantly lower than that in MD group at 2 hours after operation(p < 0.05),while that in control group and LD group was significantly lower than that in HD group(p < 0.05).There was no significant difference between control group and LD group(P > 0.05).The mean arterial pressure in LD group and HD group was significantly lower than that in MD group at 4hours after operation(p < 0.05),but there was no significant difference between other groups(P > 0.05).The mean arterial pressure of the control group was significantly lower than that of the MD group at 8 hours after operation(p < 0.05);the mean arterial pressure of the LD group and the MD group was significantly higher than that of the HD group(p < 0.05);there was no significant difference between the other groups(P > 0.05).The mean arterial pressure in the control group and HD group was significantly higher than that in the HD group 24 hours after operation(p < 0.05);the mean arterial pressure in the control group and HD group was significantly lower than that in the MD group(p < 0.05);the mean arterial pressure in the MD group was significantly higher than that in the HD group(p < 0.05);the mean arterial pressure in the other groups was significantly higher than that in the HD group(p < 0.05 There was no significant difference in pulse pressure between groups(P > 0.05).48 hours after operation,the mean arterial pressure in the control group was significantly lower than that in the MD group(p < 0.05);the mean arterial pressure in the control group was significantly higher than that in the HD group(p < 0.05);the mean arterial pressure in the LD group was significantly higher than that in the HD group(p < 0.05);the mean arterial pressure in the MD group was significantly higher than that in the HD group,and the difference was systematic.There was no significant difference in mean arterial pressure between other groups(P > 0.05).The heart rate of the control group and LD group at 2h,4h,8h,24 h after operation was significantly higher than that of the MD group and HD group(p < 0.05),but there was no significant difference among the other groups(P > 0.05).The heart rate of the control group was significantly higher than that of the MD and HD groups at 48 hours after operation(p <0.05).The heart rate of the LD group was also significantly higher than that of the MD and LD groups(p < 0.05).There was no significant difference between the other groups(P >0.05).The patients’ satisfaction scores in the control group and LD group were lower than those in the MD and HD groups,and the difference was statistically significant(p < 0.05),while there was no significant difference between the other groups(P > 0.05).The incidence of nausea and vomiting in control group was significantly higher than that in LD group,MD group and HD group(p < 0.05);the incidence of nausea and vomiting in LD group was higher than that in MD group and HD group(p < 0.05);there was no significant difference between MD group and HD group(P > 0.05).There was no significant difference in the incidence of other adverse reactions between the four groups(P > 0.05).Conclusion: Among the three doses of dexmedetomidine,3ug/kg dexmedetomidine combined with fentanyl can significantly enhance the analgesic effect after gynecological open surgery,has a slight effect on hemodynamics,has a high degree of satisfaction and reduce the incidence of side effects.