低剂量右美托咪定复合酒石酸布托啡诺用于乳腺癌根治术后静脉镇痛的临床观察

Clinical observation of low-dose dexmedetomidine combined with butorphanol tartrate for patient controlled intravenous analgesia after radical mastectomy

目的观察低剂量右美托咪定复合酒石酸布托啡诺用于乳腺癌根治术后患者自控静脉镇痛（PCIA）的临床效果。方法选择美国麻醉师协会（ASA）分级I-Ⅱ级，拟行乳腺癌根治术的女性患者70例，按随机数字表法分为单纯酒石酸布托啡诺组（B组）和低剂量右美托咪定与酒石酸布托啡诺联合用药组（DB组），每组35例。采用疼痛视觉模拟量表（VAS）评分法（O～10分）比较两组术后24、48h患者的疼痛评分，记录各时间段患者Ramsay镇静评分、酒石酸布托啡诺消耗量、哌替啶肌肉注射次数及恶心呕吐、头晕、呼吸抑制等不良反应发生率。结果两组患者均取得较好的镇痛效果，VAS评分均小于4分，且DB组患者术后24、48hVAS评分均低于B组[（3．2±0．3）分比（3-84-0．4）分、（2．74-0．3）分比（3．2±0．2）分]，差异有统计学意义（P〈0．05）。两组患者术后24、48hRamsay镇静评分比较差异无统计学意义（P〉0．05）。DB组患者酒石酸布托啡诺消耗量、哌替啶肌肉注射次数均少于B组[（6．2±1．3）mg比（7．8±1．6）mg、（2．3±1．8）次比（5.34-2．1）次]，差异有统计学意义（P〈0．05）。结论低剂量右美托咪定可提高乳腺癌根治术后酒石酸布托啡诺的PCIA效果，并有助于减少酒石酸布托啡诺消耗量和不良反应发生率。

Objective To observe the clinical effect of low-dose dexmedetomidine combined with butorphanol tartrate for patient controlled intravenous analgesia （PCIA） after radical mastectomy. Methods Seventy patients who ASA classification I - II grades with elective radical mastectomy were divided into the butorphanol tartrate PCIA group （group B）, and the dexmedetomidine combined with butorphanol tartrate PCIA group （group DB） with 35 cases each by to random digits table method. To compare two groups of 24 h and 48 h after surgery in patients with pain score by visual analog scale （VAS） scores （0-10 scores）. The Ramsay scores and the butorphanol consumption, intramuscular pethidine times were recorded in two groups. And the adverse events such as nausea and vomiting, dizziness and respiratory depression were observed. Results All patients got good analgesia in two groups, VAS scores 〈 4 scores. VAS scores at 24,48 h after operation in group DB were lower than those in group B [ （3.2 ± 0.3） scores vs. （3.8 ± 0.4） scores, （2.7±0.3） scores vs. （3.2 ± 0.2） scores ], there were significant differences （P 〈 0.05）, while there was no significant difference of Ramsay scores between two groups（P 〉 0.05 ）. And the butorphanol consumption and the intramuscular pethidine times in group DB were less than those in group B [ （6.2 ± 1.3） mg vs. （7.8±1.6） rag, （2.3 ± 1.8） times vs. （5.3 ±2.1） times, there were significant differences （P 〈0.05）. Conclusion Low-dose dexmedetomidine may improve the effect of butorphanol tartrate PCIA after radical masteetomy, and help to reduce the butorphanol tartrate consumption and adverse effects.