探讨右美托咪定复合罗哌卡因用于成年女性患者颞下颌关节手术局部浸润麻醉对术后疼痛及恶心呕吐的影响。

选取深圳市口腔医院2021年1—12月进行颞下颌关节手术的18~43岁女性患者75例，按随机数字表法分为研究组（38例）和对照组（37例）。在全身麻醉插管后，研究组采用0.5%罗哌卡因20 mL+2.0 μg/kg右美托咪定2 mL，对照组采用0.5%罗哌卡因20 mL+0.9%氯化钠溶液2 mL于术区进行局部浸润麻醉。记录两组患者主要结局指标：术后恶心呕吐（PONV）情况及频率；次要结局指标：术后4、8和24 h视觉模拟评分（VAS）值、镇痛泵有效按压次数和相应时间血流动力学指标，采用SPSS 22.0软件进行两独立样本t检验以及Fisher′s精确检验对比分析。

（1）呕吐情况：研究组轻于对照组。研究组呕吐率（13.2%）低于对照组（40.5%），差异有统计学意义（χ² = 7.188，P = 0.007）；研究组呕吐次数[（0.18 ± 0.56）次]低于对照组[（1.60 ± 2.46）次]，差异有统计学意义（t = -3.451，P = 0.001）。（2）术后VAS值比较：研究组术后4、8和24 h的VAS值分别为（2.1 ± 0.9）、（2.3 ± 0.6）和（1.5 ± 0.6），均低于对照组（3.1 ± 0.8、4.7 ± 0.8和2.5 ± 1.2），差异均有统计学意义（t_{4 h} = -4.971、t_{8 h} = -14.913、t_{24 h} = -4.471，P均<0.001）。研究组镇痛泵有效按压次数[（2.11 ± 1.47）次]显著低于对照组[（8.84 ± 1.94）次]，差异有统计学意义（t = -17.001，P<0.001）。（3）血流动力学指标：在入室、入室后1 h及出室时刻，两组收缩压差异无统计学意义（t_入室 = -1.870，P_入室 = 0.066，t_{入室1 h} = -1.583，P_{入室1 h} = 0.118，t_出室 = -1.805，P_出室 = 0.075）；对照组出室时舒张压差为（59 ± 9）mmHg（1 mmHg = 0.133 kPa），高于研究组[（55 ± 4）mmHg]，差异有统计学意义（t = -2.249，P = 0.028），在其余时间上两组差异无统计学意义。

右美托咪定复合罗哌卡因用于成年女性患者颞下颌关节手术局部浸润麻醉可以减少恶心呕吐发生率的同时提高术后镇痛效果、延长镇痛时间，值得临床推广。

To investigate the effect of dexmedetomidine combined with ropivacaine on postoperative pain, nausea and vomiting in adult female patients undergoing temporomandibular joint surgery.

A total of 75 female patients aged 18 to 43 years who underwent temporomandibular joint surgery were included in Shenzhen Stomatological Hospital from January to December 2021. They were randomly divided into the study group (38 cases) and control group (37 cases). After general anesthesia intubation, 20 mL 0.5% ropivacaine + 2 mL 2.0 μg/kg dexmedetomidine were used in the study group, and 5% ropivacaine + 2 mL normal saline were used in the control group for local infiltration anesthesia in the operation area. The main outcome measures of the two groups were recorded: postoperative nausea and vomiting (PONV) and frequency. The secondary outcome indicators included postoperative pain score (VAS) at 4 h, 8 h and 24 h, effective pressing times of analgesic pump, relative time and hemodynamic indicators. Comparative analysis was done by using two independent samples t-test and Fisher′s accurate test in software (SPSS, v. 22.0) .

1. PONV: The PONV rate of the study group (13.2%) was lower than that of the control group (40.5%) (χ² = 7.188, P = 0.007) ; The frequency of vomiting in the study group (0.18 ± 0.563, times) was lower than that in the control group (1.60 ± 2.46, times), which was statistically significant (t = -3.451, P = 0.001). 2. Postoperative pain: The VAS scores at 4 h, 8 h and 24 h after operation in the study group were 2.1 ± 0.9, 2.3 ± 0.6 and 1.5 ± 0.6, respectively, which were lower than those in the control group (3.1 ± 0.8, 4.7 ± 0.8 and 2.5 ± 1.2). The differences were statistically significant (t_{4 h} = -4.971, t_{8 h} = -14.913, t_{24 h} = -4.471, P<0.001). The pressing times of the study group[ (2.11 ± 1.47) times] were significantly lower than those of the control group[ (8.84 ± 1.94) times], which was statistically significant (t = -17.001, P<0.001). 3. Hemodynamic indexes: There was no significant difference in systolic blood pressure between the two groups at the time of entry, 1 h after entry and exit (t_entry = -1.870, P_entry = 0.066, t_{entry 1 h} = -1.583, P_{entry 1 h} = 0.118, t_exit = -1.805, P_exit = 0.075) ; The diastolic blood pressure in the control group (59 ± 9) mmHg was higher than that in the study group[ (55 ± 4) mmHg; 1 mmHg = 0.133 kPa], which was statistically significant (t = -2.249, P = 0.028). There was no statistical difference between the two groups in the rest of the timepoints.

Dexmedetomidine combined with ropivacaine for local infiltration anesthesia in adult female patients undergoing temporomandibular joint surgery can reduce the incidence of nausea and vomiting, improve the postoperative analgesic effect and prolong the analgesic time, which is worthy of clinical promotion.