右美托咪啶用于甲状腺术后病人自控静脉镇痛的效果

Effect of dexmedetomidine for patient-controlled intravenous analgesia after thyroidectomy

目的评价右美托咪啶对甲状腺术后病人自控静脉镇痛的效果。方法择期拟行单侧甲状腺次全切除术的120例病人术毕清醒拔管后均行自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)。所有患者随机分观察组和对照组。对照组PCIA用药为氟比洛芬酯150mg+舒芬太尼200μg+格拉司琼3mg+0.9%Nacl,共150mL;观察组在对照组用药的基础上加用右美托咪啶60μg,共150mL。记录术后1、4、8、16、24、48h的视觉模拟评分(visual analoguescale,VAS)、警戒/镇静评分(observe's assessment of alertness and sedation,OAA/S)、舒适度评分(bruggrmann comfortscale,BCS)、满意度评分。记录术后48hPCIA有效按压次数、氟比洛芬酯及舒芬太尼用量及不良反应情况。结果与对照组比较,观察组VAS评分降低(P<0.05);BCS评分、满意度评分升高(P<0.05);OAA/S评分差异无统计学意义(P>0.05);PCIA按压次数、氟比洛芬酯用量、舒芬太尼用量、恶心、呕吐发生率减少(P<0.05)。结论右美托咪啶对甲状腺术后病人自控静脉镇痛效果良好,可减少阿片类药物用量,同时降低不良反应的发生率。

Objective To evaluate the effect of dexmedetomidine for patient-controlled intravenous analgesia after thyroidectomy. Methods One hundred and twenty patients after unilateral subtotal thyroidectomy were link to patientcontrolled intravenous analgesia （PCIA）, when patients were awaked and after extubation. All patients were randomly divided into observe group and control group. Medication of PCIA for the observe group were dexmedetomidine 60 μg, flurbiprofen axetil 150 mg, sufentanil 200 μg, granisetron 3 mg, 0.9 % Nacl, total of 150 mL; medication of PCIA for control group were flurbiprofen axetil 150 rag, sufentanil 200 μg, granisetron 3 rag, 0.9% Nacl, total of 150 mL. Visual analogue score （VAS）, observes assessment of alertness and sedation （OAA/S）, bruggrmann comfort scale （BCS）, satisfaction scores were recorded after 1, 4, 8, 16, 24, 48 h. The number of effective compression of PCIA, flurbiprofen axetil and sufentanil consumed dosage and adverse reactions were recorded after 48 hours. Results VAS score was significantly lower （P〈0.05） in obserse group than that in control group . BCS score and satisfaction score were significantly higher （P〈0.05） in obserse group than those in control group. The number of effective compression of PCIA reduced; the amount of flurbiprofen axetil and sufentanii consumed reduced; nausea and vomiting reduced （P〈0.05） in obserse group than that in control group. OAA/S scores had no difference （P〈0.05） in two groups. Conclusion The effect of dexmedetomidine for patient-controlled intravenous analgesia after thy- roidectomy may be better and can reduce opioid consumption, while reducing the incidence of adverse reactions.