右美托咪定对上腹部手术患者术后芬太尼镇痛效果的影响

Effect of dexmedetomidine on analgesic efficacy of fentanyl in patients undergoing upper abdominal surgery

目的探讨右美托咪定对上腹部手术患者术后芬太尼镇痛效果的影响。方法将2014年8月—2016年3月76例在绍兴市中心医院择期行上腹部手术的患者分为FD组(38例)和F组(38例)。全部患者均手术过程中均采用静-吸复合全麻,术后均连接镇痛泵进行自控静脉镇痛,FD组给予400μg右美托咪定联合0.8 mg芬太尼,F组仅给予0.8 mg芬太尼。对比2组自控镇痛按压情况及芬太尼用量;分别于术后2、4、6、12、24 h,对比2组视觉模拟评分法(VAS评分)、镇痛评分法(Prince-Henry评分)、镇静评分标准(Ramsay评分);观察并记录2组并发症(恶心呕吐、过度镇静、低血压、瘙痒、心动过缓、呼吸抑制)发生情况。结果 FD组首次按压时间(77.92±15.61)min、总按压次数(29.12±9.25)次、芬太尼用量(426.71±20.53)ml均显著低于F组各指标的水平[(54.68±13.95)min,(45.36±15.34)次,(509.54±26.12)ml],差异均有统计学意义(t=7.415、5.589、15.369,均P<0.05);术后2、4、6、12、24 h,FD组VAS评分、Prince-Henry评分均显著低于F组,差异均有统计学意义(均P<0.05);2组各时间点的Ramsay评分水平对比差异无统计学意义(P>0.05);FD组不良反应的发生率(7.89%)显著低于F组(28.95%),差异有统计学意义(χ~2=4.290,P<0.05)。结论右美托咪定能显著提高上腹部手术患者术后芬太尼的镇痛效果,且能降低芬太尼用量及不良反应。

Objective To investigate the effects of dexmedetomidine on the analgesic efficacy of fentanyl in patients un- dergoing upper abdominal surgery. Methods A total of 76 patients in Shaoxing Central Hospital between August 2014 and March 2016 were divided into FD group（n = 38） and F group（ n = 38）. All patients were operated by static suction combined with general anesthesia, and the patients were all connected with the analgesia pump for self-controlled intrave- nous analgesia. FD group was given 400 μg of dexmedetomidine combined with fentanyl O. 8 mg. F group was only given O. 8 mg fentanyl. The self-controlled analgesia and the dosage of fentanyl between the two groups were compared. At 2,4, 6,12,24, the visual analogue scale （ VAS score ）, analgesia score （ Prince-Henry score ）, sedation score standard （ Ramsay score） between the two groups were compared. The complications （ nausea, vomiting, excessive sedation, hypotension, itch- ing, tachycardia, respiratory depression）were observed. Results FD group for the first time （77.92 ± 15.6I ） min, total pressing times （29.12 ± 9.25 ）times, the dosage of fentanyl （426.71 ± 20.53 ）ml were significantly lower than the level of each index of F group [ （54.68 ± 13.95 ） min, （45.36 ± 15.34） times, （509.54 ± 26.12 ） ml ]. The difference was statistically significant（t = 7. 415,5. 589,15. 369, P 〈 0.05 ）. After the surgery, at 2,4,6,12,24, VAS score and Prince- Henry score in FD group were significantly lower than those in the F group, the difference was statistically significant（ P 〈 0.05）. There was no significant difference in Ramsay scores between the two groups at different time points（ P 〉 0. 05）. The incidence of adverse reactions in group FD （7.89%）was significantly lower than that in group F（28.95 % ）, and the difference was statistically significant （ χ2 = 4. 290, P 〈 0.05 ）. Conclusion Dexmedetomidine can significantly increase the analgesic effect of fentanyl in patients undergoing abdominal surgery, and reduce the dosage of fentanyl and adverse reactions.