右美托咪定和帕瑞昔布用于玻璃体切割术镇痛疗效的比较

Comparison on analgesic effects of dexmedetomidine and parecoxib in vitrectomy

目的比较右美托咪定和帕瑞昔布用于玻璃体切割术镇痛效果。方法 75例在监测麻醉下行玻璃体切割术患者,随机分为对照组(C组)、右美托咪定组(D组)和帕瑞昔布组(P组),每组25例。D组右美托咪定0.5μg·kg^(-1),P组帕瑞昔布40 mg,均以氯化钠注射液稀释至5 mL,手术前20 min缓慢静脉泵注完毕,泵注时间为10 min;C组给予等量氯化钠注射液。其余麻醉及给药方法三组相同。记录三组各时点平均动脉压(MAP)、心率和Ramsay评分。记录术中追加局麻药的次数及术后24 h内视觉模拟量表评分(VAS)、恶心呕吐发生情况,以及术后24 h内患者使用镇痛药和止吐药的次数。结果三组ASA分级、性别、年龄、手术时间等比较差异无显著意义(P>0.05)。术中D组Ramsay评分高于P组和C组(P<0.05),D组的MAP和心率在术中低于C组(P<0.05)。术后1、3 h,D组和P组VAS评分均低于C组(P<0.05),术后6 h P组的VAS仍低于C组(P<0.05)。术中D组和P组局麻药、镇痛药应用率分别为8%和16%、8%和4%,均低于C组(52%、44%,P<0.05),D组和P组无显著差异(P>0.05)。术后24h内,D组呕吐的发生率和止吐药的应用率高于P组和C组(P<0.05)。结论右美托咪定和帕瑞昔布用于玻璃体切割术镇痛效果均良好,前者镇静效果佳但患者呕吐发生率较高,后者镇痛时间较长。

AIM To compare the analgesic effects of dexmedetomidine and parecoxib in vitrectomy. METHODS Seventy- five patients undergoing monitored anesthesia （MAC） for vitrectomy were randomly divided into three groups （25 patients in each）, and were given sodium chloride injection （group C）, dexmedetomidine （0.5 μg.kg^-1, group D） and parecoxib （40 mg, group P）, respectively. All the medication was diluted with sodium chloride injection and final volume was 5 mL. The infusion time was 10 minutes and administration was completed at 20 minutes before surgery. Mean arterial pressure （MAP）, heart rates （HR） and Ramsay scores were recorded at each time-point. The number of additional local anesthetics was recorded. The visual analogue scale （VAS）, postoperative nausea and vomiting （PONV）, the requirement of analgesics and antiemetics were recorded during 24 h after surgeries. RESULTS The demographic information of the patients was not significantly different among groups （P 〉 0.05）. Compared with group C and P, intra-operative Ramsay scores were higher and MAP and HR were lower in group D （P 〈 0.05）. Postoperative VAS in group D and P were significantly lower than those in group C at 1 h and 3 h. VAS at 6 h in group P was significantly lower than that in group C （P 〈 0.05）. The requirement of analgesics in group D and P was lower than that in group C （P 〈 0.05）. The incidence of PONV and the intake of antiemetic drugs in group D were higher than those in other groups （P 〈 0.05）. CONCLUSION Both dexmedetomidine and parecoxib exhibit satisfactory analgesic effects in vitrectomy surgery. Dexmedetomidine provides excellent sedation with relatively high incidence of PONV, and parecoxib shows longer effect of analgesia.