经尿道前列腺电切术后应用右美托咪啶行PCEA镇痛效果的研究

Study of dexmedetomidine application to postoperative patient controlled epidural analgesia after transurethral resection of the prostate

【目的】通过对经尿道前列腺电切术(transurethral resection of the prostate,TURP)患者术后使用右美托咪啶(dexmedetomidine,Dex)复合局部麻醉药物行硬膜外腔自控镇痛(patient controlled epidural analgesia,PCEA),探讨Dex复合局麻药用于TURP后PCEA的可行性和治疗效果。【方法】择期行TURP患者60例,随机分为3组:左布比卡因组(A组)、Dex低剂量组(B组)和Dex高剂量组(C组),每组20例。使用恒速镇痛泵行PCEA,注药速度为2 ml/h,PCA为0.5 ml。各组配方为:所有镇痛泵中均加入左布比卡因注射液2 mg/kg,B组另加入Dex 0.8μg/kg,C组另加Dex 1.6μg/kg,均以生理盐水稀释至100 ml。记录术后镇痛期间患者的基础血压、心率、视觉模拟评分法(visual analogue scale,VAS)评分、下肢运动神经阻滞Bromage评分、膀胱痉挛及不良反应发生例数,并进行统计学分析。【结果】A组在术后8 h到术后24 h心率和基础血压较基础值明显升高(P<0.05或P<0.01),B组和C组HR和基础血压无明显变化;B组和C组VAS最高分别为(3.3±1.2)和(2.5±0.9),明显低于A组(5.9±1.9)(P<0.05或P<0.01);C组下肢肌力恢复时间为8 h明显晚于A组和B组4 h(P<0.01);按压PCA次数B组(28次)和C组(7次)明显少于A组(108次)(P<0.01);B组和C组膀胱痉挛发生率分别为0%和10%明显低于A组45%(P<0.05)。【结论】Dex在硬膜外腔使用可有效的增强局麻药PCEA的镇痛效果,降低TURP后膀胱痉挛发生率,从而减轻患者术后疼痛引起的血流动力学变化。但当Dex浓度较大时,下肢肌力恢复时间会有所延长。

[Objective]To explore the feasibility and therapeutic effectiveness of dexmedetomidine （Dex） plus local anesthetic for post- operative patient controlled epidural analgesia （PCEA） after transurethral resection of the prostate （TURP）. [ Methods] Sixty patients who would make PCEA after TURP were randomly divided into three groups： levobupivaeaine group （A group）, low dose Dex group （B group） and high dose Dex group （C group）, 20 patients per group. Automatic control acesodyne pump was employed for every patient to make PCEA. The pump was set for injection 2 ml/h and PCA 0.5 ml. The formulae were： A group only levobupivacaine 2 mg/kg, B group levobupivacaine 2 mg/kg plus Dex 0.8 μg/kg, C group levobupivacaine 2 mg/kg plus Dex 1.6 μg/kg; and each was diluted with normal saline to 100 ml. We recorded every postoperative patient＇s MAP, HR, visual analogue scale （VAS）, blocked motor nerve Bromage score of lower limbs, the incidence of bladder spasm and adverse reactions, and analyzed the data statistically. [ Result] Compared with the base values ,there was a significant rise of HR and MAP in A group from postoperative 8 h to 24 h（P〈0.05 or P〈0.01）, but no obvious change in B group and C group. The maximum VAS scores of B group and C group （3.3：1：1.2 and 2.5 ± 0.9 respectively） were signifi- cantly lower than that of A group （5.9 ± 1.9） （P〈0.01 or P〈0.05）. The recovery of lower limb myodynamies in C group lasted 8 hours which was later than that in A group and B group, 4 h （P〈0.01）. The number of PCA in B group and C group was obviously less than that in A group （P〈0.01）. The incidence rates of bladder spasm in B group and C group （ 0% and 10% respectively） were significantly lower than that in A group （45%）（P〈0.05）. [Conclusion] Used in epidural space, Dex could enhance the effect of local anesthetics for PCEA, reduce the incidence rate of bladder spasm after TURP, and relieve the haemodynamic change caused by postoperative pain. However, if the concentration of Dex is excessive, it would delay the recovery of lower limb myodynamics.