小剂量右美托咪定对老年人直肠癌根治术后镇痛效果及舒适度的影响

The effect of small doses of dexmedetomidine on postoperative analgesia and comfort after colorectal cancer radical operation in elderly patients

目的：观察小剂量右美托咪定对老年人直肠癌根治术后镇痛效果及舒适度的影响。方法选择ASAⅠ～Ⅱ级择期在全麻下行直肠癌根治术老年患者60例，按随机数字表法分成右美托咪定组（ D组）和对照组（C组），每组30例。 D组患者在全麻诱导前泵注0．5μg／kg右美托咪定，15 min泵注完毕，术中维持0．2μg· kg－1· h－1右美托咪定至手术结束前10 min；C组泵注同样容量的0．9％氯化钠注射液。记录手术时间、芬太尼使用量，24 h内进行舒适度及VAS评分，维持VAS评分≤3分。当VAS评分＞3分时，给予按压静脉自控镇痛（ PCIA）泵，并记录患者按压PCIA次数。同时记录两组患者在24 h内发生恶心呕吐等不良反应的情况。结果两组术后镇痛效果良好，但D组PCA后各时点VAS评分小于C组（ t术毕＝5．99，t术后2 h ＝4.76，t术后4 h ＝4．08，均P＜0．01），Bruggrmann舒适度评分大于C组（t术毕＝9．86，t术后2 h ＝4．91，t术后4 h ＝6．84，均P＜0．01）。 D组不良反应发率为13．30％，低于C组的26．67％（χ2＝4．32，P＜0．05）。结论小剂量右美托咪定可以改善老年直肠癌根治患者镇痛效果，提高舒适度，不良反应发生率降低，且具有减少术后恶心呕吐的作用。

Objective To observe the effect of small doses of dexmedetomidine on postoperative analgesia and comfort after colorectal cancer radical operation in elderly patients .Methods 60 cases of elderly patients for elective colorectal cancer resection ,ASAⅠ~Ⅱgrade anesthesia were selected .According to randomly digital table , they were divided into the dexmedetomidine given group （ group D） and control group （ group C）,30 cases in each group.The patients of group D was given to 0.5μg/kg dexmedetomidine for induction of anesthesia infusion , 15minutes bolus injection was completed ,intraoperative maintain 0.2μg· kg-1 · h-1 dexmedetomidine fixed to the front end of surgery 10 min.And group C was given to infusion of 0.9%sodium chloride injection in the same capacity . The operation time, amount of fentanyl using , comfort and VAS scores were recorded within 24h, maintain VAS score≤3 points.When VAS score〉3 points,the pressing PCA was given ,and the number of times of pressing the PCIA was recorded.The adverse reactions occurred within 24h such as nausea and vomiting were also recorded . Results In the two groups,the results of postoperative analgesia were good ,but the VAS score of group D at each time of PCA point were less than those of group C （tend of surgery =5.99,tafter operation 2h =4.76,tafter operation 4h =4.08,all P〈0.01）.The Bruggrmann comfort score of group D were greater than those of group C （tend of surgery =9.86,tafter operation 2h =4.91,tafter operation 4h =6.84,all P〈0.01）.The incidence of adverse reactions of group D was 13.30%,which was less than 26.67%of group C（χ2 =4.32,P〈0.05）.Conclusion Small doses of dexmedetomidine given to improve the analgesic effect in elderly patients with colorectal cancer cure can improve comfort and reduce the incidence of adverse reactions ,and has a role in reducing postoperative nausea and vomiting .