右美托咪定联合利多卡因用于乳腺癌改良根治术后镇静镇痛

Sedative and Analgesic Effect of Dexmedetomidine Combined with Lidocaine after Modified Radical Mastectomy for Breast Cancer

目的：比较不同剂量右美托咪定与利多卡因联合静注对乳腺癌改良根治术患者术后镇静、镇痛的疗效和安全性。方法：择期乳腺癌改良根治术患者60例随机分为3组：利多卡因组（L组,n=20）,术前予利多卡因1.5 mg.kg-1静注后,以1.5 mg .kg-1.h-1静脉泵注利多卡因至术终；低剂量右美托咪定联合利多卡因组（D1组,n=20）,术前予右美托咪定0.3μg.kg-1,10 min内静脉泵注后,以1.5 mg.kg-1.h-1静脉泵注利多卡因至术终；高剂量右美托咪定联合利多卡因组（D2组,n=20）,术前给予右美托咪定0.6μg.kg-1,10 min内静脉泵注后,以1.5 mg.kg-1.h-1持续静脉泵注利多卡因至术终。比较3组患者苏醒期改良OAA/S评分达到3级及BIS达到80时,丙泊酚效应室浓度（Ce3, Ce80）；术后1 h,6 h及24 h的VAS评分（VAS1~VAS 24）；术后24 h内恶心,呕吐情况。结果：3组患者苏醒期改良OAA/S评分达到3级及BIS达到80时各组间丙泊酚效应室浓度比较,差异无统计学意义（P＞0.05）。 D1、D2两组术后1 h VAS值较L组明显降低（P＜0.05）,D1、D2两组间比较,差异无统计学意义（P＜0.05）。术后6 h及24 h的VAS值,D2组明显低于L、D1组（P＞0.05）,L组与D1组比较,差异无统计学意义（P＜0.05）。各组间药品不良反应差异无统计学意义（P＞0.05）。结论：右美托咪定0.6μg.kg-1和利多卡因联合应用可明显减轻术后急性疼痛,优化患者短期预后,安全性好。

Objective：To compare the sedative and analgesic effect and safety of dexmedetomidine at different doses combined with lidocaine with intravenous administration after modified radical mastectomy for breast cancer. Methods：Sixty ASAⅠ-Ⅱpatients aged from 18 to 65 years with body weight index of 18-30 kg.m-2 were treated by modified radical mastectomy. The patients were randomly divided into 3 groups：lidocaine group （group L, n=20）, low dosage dexmedetomidine and lidocaine group （group D1, n=20） and high dosage dexmedetomidine and lidocaine group （group D2, n=20）. Group L was intravenously given lidocaine 1. 5 mg.kg-1 before the operation and intravenously infused lidocaine 1. 5 mg.kg-1 .h-1 during the whole operation process. Group D1 was intravenously infused dexme-detomidine 0. 3μg.kg-1 in 10min before the operation, and intravenously infused lidocaine 1. 5 mg.kg-1 .h-1 during the whole opera-tion process. Group D2 was intravenously infused dexmedetomidine 0. 6 μg.kg-1 in 10min before the operation, and intravenously in-fused lidocaine 1. 5 mg.kg-1 .h-1 during the whole operation process. The propofol Ce was recorded when the modified OAA/S reached 3 （Ce3） and BIS reached 80 （Ce80） during the up period, the VAS in the 1st, 6th and 24th hour after the surgery （VAS1-24）, and nausea and vomiting in the first postoperative day were also recorded and observed. Results：No difference was found in the demographic data among the 3 groups with modified OAA/S of 3 （Ce3） and BIS of 80 （Ce80）. VAS of group D1 and D2 was significantly decreased when compared with group L in the 1st postoperative hour（P〈0. 05）. In the 6th and 24th postoperative hour, VAS of group D2 was much lower than that of group L and D1（P〈0. 05）, however, no difference was found between group L and D1. There was no significant difference in the propofol Ce during the up period and the adverse reactions in the 1st postoperative day among the 3 groups. Conclusion：Dexmedetomidine at the dosage of 0. 6 μg.kg-1 combined with lidocaine can significantly reduce the pain and optimize the short-term prognosis after modified radical mastectomy.