右美托咪啶复合地塞米松超前镇痛在食管癌手术中的应用

The Application of Preemptive Analgesia of Dexmedetomidine in Combination with Dexamethasone in Patients with Esophageal Carcinoma Surgery

目的：观察预先静点右美托咪啶复合地塞米松用于食管癌手术超前镇痛的效果。方法：ASAⅠ～Ⅱ级择期食管癌手术患者60例,随机分为三组,每组各20例,将右美托咪啶配成4μg/mL浓度,A组在切皮前30 min静脉输注右美托咪啶0.5～1μg/kg＋地塞米松10 mg,B组在切皮前30 min静脉输注右美托咪啶0.5～1μg/kg,C组在切皮前30 min静脉输注生理盐水,三组均在术毕前30 min关闭,同时三组均在缝皮时停用瑞芬太尼和丙泊酚,术毕前30 min停用吸入药,静注芬太尼0.05 mg。三组分别于术后1、4、8、12 h对切口疼痛进行VAS、BCS评分,并观察三组患者术后追加使用哌替啶的时间、例数及次数。结果：A组术后1、4、8、12 h疼痛评分均低于B、C两组（P〈0.05）,术后使用哌替啶的时间及次数也均低于后两组（P〈0.05）。结论：右美托咪啶复合地塞米松超前镇痛用于食管癌手术,不仅能有效缓解术后切口疼痛,减少术中静脉麻醉药及术后镇痛药的用量,消除术后患者的应激及不良反应,而且无术后呼吸抑制,有利于患者早日康复。

Objective： To observe the preemptive analgesia effects of intravenous dexmedetomidine in combination with dexamethasone in patients with esophageal carcinoma surgery.Method： 60 patients graded as ASA Ⅰ-Ⅱ who were undergoing elective esophageal carcinoma surgery were selected. They were randomly divided into three groups, 20 patients in each group. Group A： dexmedetomidine 0.5-1 μg/kg and dexamethasone 10 mg. Group B： dexmedetomidine 0.5-1 μg/kg. Group C： saline. In each group intravenous infusion was given at 30 minutes before skin incision and was stopped at 30 minutes before closing. VAS and BCS score were assessed in postoperative 1, 4, 8, 12 h in each individual group. Time, the number of cases, and the number of times of postoperative additional use of pethidine were observed. Result： VAS and BCS score of Group A were all lower than that of Group B and C （P〈0.05）. The time and times of postoperative use of pethidine were all lower than those of Group B and C （P〈0.05）.Conclusion： Dexmedetomidine in combination with dexamethasone is used for preemptive analgesia in patients with esophageal carcinoma surgery can relieve postoperative incision pain, reduce the dose of analgescs and its side effects, eliminate stress of postoperative patients and adverse reactions, and no postoperative respiratory depression, help the patients to recover.