不同剂量右美托咪啶复合氟比洛芬酯在乳腺术后镇痛中的应用

Application of different dose of dexmedetomidine combined with flurbiprofen in postoperative analgesia of breast surgery

目的研究右美托咪啶复合氟比洛芬酯在乳腺术后的镇痛作用。方法选择ASAⅠ-Ⅱ级90例全麻下行乳腺手术患者,随机分3组:A组(对照组),给予氟比洛芬酯150mg;B组,给予氟比洛芬酯150mg+右美托咪啶0.02μg/(kg.h);C组,给予氟比洛芬酯150mg+右美托咪啶0.04μg/(kg.h),生理盐水稀释至100mL。记录手术前(T0),手术后2h(T1),4h(T2),8h(T3),24h(T4),48h(T5)时的心率(RR)、血压(BP)、血氧饱和度(SPO2),呼吸(RR),疼痛(VAS评分法)和镇静评分(Ramsay分级法)。并观察术后48h内有无出现恶心、呕吐、头晕、嗜睡、呼吸抑制等不良反应发生情况。结果 A、B、C三组术后的血压均高于术前,但术后B、C两组的血流动力学均较A组更稳定,比较差异有统计学意义(P<0.05)。2h～8h内B、C两组和A组比较镇痛VAS评分和镇静Ramsay评分有统计学意义。A组恶心、呕吐的发生率大于B、C组,C组嗜睡发生率大于A、B两组,但均无统计学意义。结论 0.02μg/(kg.h)的右美托咪定与氟比洛芬酯可安全有效地应用于乳腺术后镇痛。

Objective To evaluate the efficacy and safety of combined dexmedetomidine and flurbiprofen in the postoperative analgesia of breast surgery. Methods Ninety patients （ASA I - Ⅱ ） undergoing breast surgery were randomly divided into three groups（n=30 each）, group A （administration of 150 mg of flurbiprofen）,group B （administration of 0.02 μg/（kg.h）of dexmedetomidine and 150 mg of flurbiprofen）and group C （administration of 0.04 μg/（kg· h）of dexmedetomidine and 150 mg of flurbiprofen）. All the postoperative analgesia pumps were adjusted in a standard of 100 mL volume. The heart rate （HR）, blood pressure （BP）, oxygen saturation （SPO2）, respiratory rate （RR）, pain levels （VAS assessment） and sedation scores （Ramsay assessment） of the patients were recorded at different time-points before operations and 2 h （T1）, 4 h （T2）, 8 h （T3）, 24 h （T4）, 48 h （TS） after operations. The side effects of these using medicine were also evaluated in the present study. Result BP in three groups after surgery were higher than that before surgery. But the hemodynamics in group B and group C were more stable than group A. The comparison among these three groups in BP and HR had statistic differences. The pain levels and the sedation scores within 8hr after operations in group B and group C are better than group A. The ratio of adverse events, such as nausea and vomiting, were less in group B and C. Conclusion The use of combination of dexmedetomidine 0.02 μg/（kg.h） and flurbiprofen can be used in the postoperative analgesia of breast surgery effectively and safely.