摘要
目的探讨联合应用右美托咪定(dexmedetornjdine,Dex)和舒芬太尼对腹腔镜子宫全切患者术后患者自控静脉镇痛(patients controlled intravenousanalgesia,PCIA)效果的影响。方法选择美国麻醉医师协会(ASA)分级Ⅰ-Ⅱ级择期行腹腔镜子宫全切术患者75例,术后采用随机数字表法分为3组:低剂量舒芬太尼组(S1组)、高剂量舒芬太尼组(S2组)、Dex联合舒芬太尼组(DS组),每组25例。3组患者术后PCIA泵(200m1)设置均为:背景剂量,1ml/h(S1组,舒芬太尼0.02μg·kg-1·h-1;s2组,舒芬太尼0.04μg·kg-1·h-1;DS组,Dex和舒芬太尼均为0.02μg·kg-1·h-1);单次剂量,1ml;锁定时间,8min。分别记录术后1(T1)、4(T2)、8(T3)、12(T4)、24(T5)、48(T6)、72h(T7)视觉模拟评分法(visualanaloguescales,VAS)评分、Ramsay镇静评分、PCIA有效按压/总按压次数和术后72h舒芬太尼消耗量。观察患者术后72h恶心、呕吐、皮肤瘙痒、呼吸抑制等副作用和患者满意度。结果与S2组T1~T4时静息VAS评分(VASr)和咳嗽VAS评分(VASm)[VASr分别为(2.98±0.77)分、(2.67±0.57)分、(2.33±0.65)分、(2.12±0.44)分,VASm分别为(5.21±2.01)分、(4.32±1.13)分、(3.78±1.10)分、(3.12±0.86)分]比较,DS组相应时间点评分[VASr分别为(2.03±0.64)分、(1.65±0.47)分、(1.62±0.49)分、(1.57±0.50)分,VASm分别为(4.02±1.41)分、(2.61±0.93)分、(2.43±0.72)分、(2.44±0.74)分]均明显降低(P〈0.05)与S1组比较,S2组和DS组静息和咳嗽时各时间点VAS评分明显降低(P〈0.05)。S1组、S2组、DS组术后72h舒芬太尼的消耗量分别为:(208±36)、(240±41)、(165±38)μg,与S1组和S2组比较,DS组舒芬太尼消耗量明显降低(P〈0.05o3组患者术后各时间点Ramsay镇静评分、镇痛满意度、有效按压次数/总按压次数比较,差异无统计学意义(P〉0.05)。S1组恶心、呕吐发生例数分别为10例(40%)、4例(16%),S2组恶心、呕吐、皮肤瘙痒发生例数分别为12例(48%)、4例(16%)、3例(12%),DS组恶心发生例数为5例(20%)结论对于腹腔镜子宫全切患者术后镇痛,联合应用Dex和舒芬太尼效果较单纯应用舒芬太尼优,且并发症减少,可以安全有效地应用于临床。
Objective To observe the effect of combination of dexmedetomidine and sufentanil on postoperative analgesia for patients undergoing laparoscopic hysterectomy. Methods Seventy-five (ASAⅠ-Ⅱ) patients undergoing laparoscopic hysterectomy were randomly allocated into three groups (n=25) after surgery: low-dose sufentanil group (group S1 ), highose sufentanil group (groupS2), dexmedetomidine and sufentanil group (group DS). All patients of the three groups received patients controlled intravenous analgesia (PCIA) after operation. The following setting: background, 1 ml/h (group SI: sufentanil 0.02 μg·kg-1·h-1, group $2: sufentanil 0.04μg·kg-1·h-1, group DS: dexmedetomidine and sufentanil 0.02 μg·kg-1·h-1, each). Bolus: 1 ml. Lock time: 8 rain. The scores of visual analogue scales (VAS) and Ramsay at 1 (T1),4 (T2),8 (T3),12 (T4),24 (T5),48 (T6),72 h (T7) after aperation, effective presses/total presses of PCIA, the consumption of sufentanil during 72 h after operation, nausea and vomiting, pruritus, respiratory depression and the satisfaction degree of patients were recorded. Results Compared with group $2 from T1 to T4 (VASr:2.98±0.77, 2.67±0.57, 2.33±0.65, 2.12±0.44. VASm:5.21±2.01, 4.32±1.13, 3.78±1.10, 3.12±0.86), the scores of VAS (both at rest and movement, VASt and VASm) in group DS (VASr:2.03±0.64, 1.65±0.47, 1.62±0.49, 1.57±0.50. VASm: 4.02±1.41, 2.61±0.93, 2.43±0.72, 2.44±0.74)significantly decreased (P〈0.05). Compared with group S1, the scores of VAS (both at rest and movement) significantly decreased in group S2 and DS at each time point (P〈0.05). While there were no significant difference in the scores of Ramsay, effective presses/total presses of PCIA and satisfaction degree of patients (P〉0.05). The consumption of sufentanil during 72 h after operation of group S1, S2, DS were respectively as follows: (208±36), (240±41), ( 165± 38) p.g, compared with group S1 and S2, the consumption of sufentanil significantly decreased in group DS (P〈0.05). The number of nausea and vomiting in group S1 were 10 (40%) and 4 (16%), while nausea, vomiting and pruritus in group S2 were 12 (48%), 4 (16%) and 3 (12%). Only 5 patients (20%) in group DS had nausea, but no vomiting. Conclusions Combination of dexmedetomidine and sufentanil (0.02μg·kg-1·h-1, each) was superior to simply application of sufentanil on the effect of postoperative analgesia for patients undergoing laparoscopic hysterectomy and complications decreased. This method can be safe and effective in clinical application.
出处
《国际麻醉学与复苏杂志》
CAS
2015年第8期691-695,共5页
International Journal of Anesthesiology and Resuscitation
关键词
右美托咪定
舒芬太尼
腹腔镜子宫全切术
术后镇痛
Dexmedetomidine
Sufentanil
Laparoscopic hysterectomy
Postoperative analgesia