右美托咪定联合舒芬太尼在胸腔镜下食道癌根治术术后自控镇痛中的应用效果

Patient-controlled analgesia with dexmedetomidine and sufentanil after thoracoscopic esophageal radical resection

目的探究右美托咪定联合舒芬太尼在胸腔镜下食道癌根治术术后自控镇痛中的应用效果。方法抽取2013年10月至2016年1月于本院择期行食管癌根治术的患者64例，根据麻醉方式不同分为对照组（n=32）和研究组（n=32）。对照组给予舒芬太尼＋生理盐水术后自控镇痛，研究组给予舒芬太尼＋右美托咪定术后自控镇痛。对比术后不同时间段两组疼痛评分（VAS）、镇静评分（Ramsay），并统计两组不良反应发生率。结果术后1h、4h、12h、1d，研究组VAS评分分别为（2．29±0．46）分、（2．01±0．39）分、（1．32±0．26）分、（1．17±0．21）分，均明显优于对照组，差异有统计学意义（均P〈0．05）；术后1h、4h，研究组Ramsay评分分别为（3．11±0．40）分、（2．71±0．40）分，均明显优于对照组，差异有统计学意义（均P〈0．05）；研究组不良反应发生率（6．26％）明显低于对照组（31．26％），差异有统计学意义（P〈0．05）。结论在胸腔镜下食道癌根治术术后自控镇痛中联合应用右美托咪定及舒芬太尼效果显著，可有效提高镇痛及镇静效果，且能降低不良反应发生率。

Objective To investigate the effect of patient-controlled analgesia with dexmedetomidine and sufentanil after thoracoscopic esophagectomy. Methods 64 patients with esophageal cancer undertaking thoracoscopic esophagectomy at our hospital from October, 2013 to January, 2016 were selected and divided into a control group （n=32） and a study group （n=32） according to different anesthesia methods. The control group were given normal saline and sufentanil for postoperative analgesia and the study group were given patient- controlled analgesia with sufentanil and dexmedetomidine. The pain score （VAS） and sedation score （Ramsay） were compared between these two groups at different time periods; and the incidence of adverse reactions in the two groups were compared. Results 1 h, 4 h, 12 h, and 1 d after the operation, the VAS scores were （2.29 ± 0.46）, （2.01±0.39）, （1.32±0.26）, and （1.17 ±0.21） in the study group, which were significantly better than those in the control group, with statistical differences （all P 〈 0.05）. 1 and 4 h after the surgery, the Ramsay scores were （3.11 ± 0.40） and （2.71 ± 0.40） in the study group, which were significantly better than those in the control group, with statistical differences （all P 〈 0.05）. The incidence of adverse reactions was significantly lower in the study group than the control group （6.26% vs. 31.26%）, with a statistical difference （P 〈 0.05）. Conclusions Patient- controlled analgesia with dexmedetomidine and sufentanil after thoracoscopic esophageal radical resection can effectively improve the analgesic and sedative effects and reduce the incidence of adverse reactions.