右美托咪定辅助舒芬太尼用于胃癌术后静脉镇痛的剂量探讨

Dosage study of dexmedetomidine-assisted sufentanil administration on vein analgesia after gastric cancer surgery

目的探讨右美托咪定辅助舒芬太尼用于胃癌患者术后自控静脉镇痛(PCIA)的安全、有效剂量。方法 80例ASAⅠ或Ⅱ级胃癌根治手术的患者,采用随机双盲抽签方法均分为四组。PCIA镇痛液配方:舒芬太尼组(SF组),舒芬太尼3μg/h+托烷司琼5mg;右美托咪定1组(D1组),右美托咪定0.05μg·kg-1·h-1+舒芬太尼2μg/h+托烷司琼5mg;右美托咪定2组(D2组),右美托咪定0.1μg·kg-1·h-1+舒芬太尼2μg/h+托烷司琼5mg;右美托咪定3组(D3组),右美托咪定0.15μg·kg-1·h-1+舒芬太尼2μg/h+托烷司琼5mg,均用生理盐水配成100ml。清醒拔管后行PCIA,记录术后4、8、16、24和48h的MAP、HR、SpO2、RR,并进行疼痛、镇静、情绪、睡眠质量的评分,记录不良反应发生率,术后第3天对使用PCIA治疗的患者满意度进行综合评价。结果与SF组比较,术后4、8、16、24和48hD2、D3组MAP明显降低,D1、D2、D3组HR明显减慢(P<0.05或P<0.01);Ramsay镇静评分明显升高(P<0.05或P<0.01)。术后48h内睡眠、情绪评分D1、D2、D3组明显优于SF组(P<0.05或P<0.01);D1、D2、D3组术后恶心呕吐和寒颤发生率明显低于SF组(P<0.05);随着右美托咪定剂量增加需干预的心动过缓明显增加,术后第3天D2、D3组患者对PCIA的满意程度明显优于SF组(P<0.05)。结论右美托咪定0.1μg·kg-1·h-1复合舒芬太尼2μg/h术后行PCIA在获得满意镇痛效果的同时,还能提供适度镇静,消除患者焦虑情绪,提高围术期的安全性和患者满意度。

Objective To investigate the effective and safety dosage of dexmedetomidine, which assist sufentanil administration for postoperative gastric cancer. Methods Eighty patients ASA Ⅰor Ⅱ with gastric cancer were randomly were divided into; a randomized, double-blind, balloting on sufentanil group （group SF）, dexmedetomidine group （groups D1, D2, D3）. Group SF,sufentanil 3 ~tg/h＋ tropisetron 5 mg; group De, dexmedetomidine 0.05 μg·kg^-1·h^-1＋sufentanil 2 μg/h ＋tropisetron 5 mg; group D2, dexmedetomidine 0.1μg·kg^-1·h^ ＋sufentanil 2 μ/h＋ tropisetron 5 mg; group IDa, dexmedetomidine 0.15 μg·kg^-1·h^-1＋sufentanil 2 μg/h＋tropisetron 5mg. saline paired 100ml. PCIA were administrated after extubation. At 4, 8, 16, 24 and 48 h postoperatively BP, HR, SpO2, RR, and pain, sedation, mood, sleep quality score were record. At the same time, total evaluations of patient satisfaction degree were done on the 3rd day postoperatively after using the PCIA treatment. Results Compare with group SF , MAP in groups De, Ds and HR in groups D1, De, De were significantly decreased at 4, 8, 16, 24 and 48h postoperatively（P〈0.05）. Ramsay score in groups D~ ,De ,Ds were significant better than group SF at the same time point（P〈0.05 or P〈0.01）; mood and sleeping score in groups De, De, Da significant better than group SF at 48h postoperatively; postoperative nausea and vomiting and chills incidence in groups D1 ,D2 ,D3 were significant lower than those of group SF（P〈0.05）. intervention bradycardia with dexmedetomidine given dose is increased significantly, on the 3rd day postoperatively, ：satisfaction rate of patients on PCIA in groups De and De were significant better than that of group SF（P〈0.05）. Conclusion Dexmedetomidine 0.1 μg·kg^-1·h^-1＋combination with sufentanil 2 μg/h administration in postoperatively PCIA acquired satisfied analgesic effect and provided moderately calm, eliminated the patient anxious mood, enhanced the security in the perioperative period and the degree of satisfaction, is very suitable for marketing in clinical using.