地佐辛与右美托咪定联合舒芬太尼对胶质瘤患者术后唤醒及镇痛的比较

Comparison of dezocine compared with dexmedetomidine combined with sulfentanyl on postoperative awakening and analgesia in glioma

目的探讨舒芬太尼分别联合地佐辛与右美托咪定对胶质瘤手术患者术后唤醒及镇痛的比较。方法选取行胶质瘤手术的46例患者,随机分成D组和Y组,每组23例。在术前结束30 min,D组给予舒芬太尼联合地佐辛镇痛,Y组给予舒芬太尼联合右美托咪定镇痛,观察患者术后唤醒时间、血清致痛物水平,术后视觉模拟评分法(visual analogue scale,VAS)及Ramsay镇静评分,患者镇痛满意率。结果与D组比较,Y组术后唤醒时间较短(P<0.05),术后24、48 h 5-羟色胺水平较高,P物质水平较低(P<0.05),Y组术后24、48 h VAS评分较低(P<0.05),12、24、48 h Ramsay镇静评分较低(P<0.05)。Y组镇痛满意程度显著优于D组,2组比较差异有统计学意义(Z=-2.940,P=0.003<0.01)。D组不良反应总发生5(21.74%)例与Y组4(17.39%)例比较差异无统计学意义。结论舒芬太尼联合右美托咪定对胶质瘤术后有较好的镇痛效果,明显缩短术后唤醒时间及抑制血清致痛物水平,优于舒芬太尼联合地佐辛用药。

Objective To compare dezocine compared with dexmedetomidine combined with sulfentanyl on postoperative awakening and analgesia in patients with glioma. Methods A total of 46 patients with glioma surgery were collected and randomly divided into D group and Y group with 23 cases in each group. At the end of 30 minutes pre-surgery, patients in the D group were treated by sulfentanyl combined with dezocine, patients in the Y group were treated by sulfentanyl combined with dexmedetomidine. The wake up time and levels of algogenic substance postoperation, visual analogue scale （ VAS）, Ramsay score and analgesia satisfaction were observed. Results Compared with D group, the wake up time of Y group was shorter（ P 〈 0. 05 ）, 5-hydroxytryptamine on 24 h and 48 h postoperation of Y group were higher and substance P was lower （ P 〈 0. 05 ） , VAS score on 24 h and 48 h postoperation of Y group were lower （ P 〈 0.05 ）. The analgesia satisfaction in Y group was better than that in D group （ Z = - 2. 940, P = 0. 003 〈 0. 01）. There were no significantly difference in total adverse reactions between D group [ 5 （21.74%）] and Y group [ 4 （17. 39% ）]. Conclusion Sulfentanyl combined with dexmedetomidine in the treatment of glioma after surgery has a good analgesic effect and significantly shorten wake up time after surgery and inhibit the serum level of algogenic substance, which is superior to sulfentanyl combined with dezocine medication.