右美托咪定联合芬太尼用于妇科患者术后自控静脉镇痛的安全性和有效性

Safety and Efficacy of Dexmedetomidine Combined with Fentanyl in Postoperative Patient-Controlled Intravenous Analgesia for Gynecologic Laparotomy Patients

目的评价右美托咪定用于妇科开腹手术术后患者自控静脉镇痛(PCIA)的安全性和有效性。方法 80例ASAⅠ或Ⅱ级的开腹全子宫切除术或子宫肌瘤剔除术的全麻患者,随机分为两组(n=40):右美托咪定复合芬太尼组(DF组)、芬太尼组(F组),术毕按两种方案实行患者自控静脉镇痛(PCIA)。在PCIA开始1,4,8,16,24 h观察并记录患者的生命体征、疼痛评分、镇静评分、PCIA使用次数、QoR-9术后恢复质量评分及不良反应,在手术前1天及术后6,24,72 h用简易精神状态量表(MMSE)评价患者认知功能。结果 DF组患者仅在术后1 h心率较术前升高(P<0.05),在术后1,4 h平均动脉压高于术前(P<0.05),其术后恢复至术前水平;F组的患者术后的心率均高于术前(P<0.05),平均动脉压直至24 h才恢复至术前(P<0.05)。与芬太尼组相比,右美托咪定复合芬太尼组明显降低芬太尼的用量(P<0.05)。两组患者术后6 h MMSE值均有所降低,但24 h后均恢复至术前水平。结论右美托咪定与芬太尼联合应用,可以减少芬太尼的用量并达到良好的镇痛效果,患者生命体征更平稳,不影响术后认知功能,是一种安全有效的术后静脉镇痛方法。

Objective To evaluate safety and efficacy of dexmedetomidine in postoperative patient-controlled intravenous analgesia（PCIA） for gynecologic laparotomy patients. Methods Eighty patients（ 18-65 years of age, ASA Class I or ]I ） undergoing abdominal hysterectomy or myomectomy, were randomly divided into two groups：dexmedetomidine combined with fentanyl group （Group DF, 40 cases） and fentanyl group （Group F, 40 cases ）. The patients in Group 1）F received fentanyl 10 μg·mL-1 plus dexmedetomidine 2μg·mL-1, and the patients in Group F received fentanyl 10 μg·mL-1 for PCIA. Cumulative PCIA requirements, Visual analogue pain score （ VAS ）, Remesay sedation score （ RSS ）, Vital signs （ heart rate, blood pressure, respiratory rate, SpO2 ）, post-operative quality of recovery score（ QoR9 ）, and PC1A-related adverse events were recorded for 24 h after operation. The Mini-Mental State Examination（MMSE） score was evaluated to assess the cognitive function before and after the operation. Results The heart rate of patients in Group DF stablized within 1 h after operation, and the mean arterial pressure returned to the preoperative level 4 h after operation; yet the heart rate and mean arterial pressure in Group F remained elevated 24 h after operation（ P〈0. 05 ）. Compared with Group F, the doses of fentanyl in Group DF were significantly decreased（P〈0.05 ）. There was no significant decrease in MMSE scroe 1 day after operation. Conclusion Dexmedetomidine combined with fentanyl in PCIA may be the effective and safe for gynecologic laparotomy patients.