泵注右美托咪啶对上腹部手术患者术后芬太尼自控静脉镇痛效果的影响

Effect of infusion of dexmedetomidine on postoperative patients with upper abdominal surgery after fentanyl for patient-controlled intravenous analgesia

目的探讨泵注右美托咪啶对上腹部手术患者术后芬太尼自控静脉镇痛效果的影响。方法将2015年2月—2016年4月74例在绍兴市中心医院择期进行上腹部手术的患者分为观察组和对照组。全部患者术后给予自控静脉镇痛。观察组采用右美托咪啶联合芬太尼,对照组仅采用芬太尼。于术后1、6、12、24、48 h对比2组患者平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_2)、疼痛视觉模拟(VAS)评分、镇静(Ramsay)评分;对比2组有效按压次数、芬太尼剂量及不良反应发生情况。结果观察组有效按压次数、48 h芬太尼剂量均显著低于对照组,差异有统计学意义(P<0.05);观察组术后1、6、12、24 h的MAP、HR显著低于对照组,差异有统计学意义(P<0.05)。2组术后各时间点SpO_2水平对比差异无统计学意义(P>0.05);术后1、6、12、24 h观察组VAS评分显著低于对照组,Ramsay评分显著高于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率(8.11%)显著低于对照组(29.73%),差异有统计学意义(χ~2=5.638,P<0.05)。结论上腹部手术患者采用右美托咪啶联合芬太尼进行术后自控静脉镇痛,与单独运用芬太尼相比,能取得更好的镇痛及镇静效果,能有效降低芬太尼剂量,减少不良反应的发生。

Objective To investigate the effect of infusion of dexmedetomidine on postoperative patients with upper abdominal surgery after fentanyl for patient-controlled intravenous analgesia. Methods Seventy-four patients in our hospital were divided into observation group and control group. Postoperative patient controlled intravenous analgesia. The observation group with dexmedetomidine combined with fentanyl. The control group was only used fentanyl. After 1,6,12,24,48 hours,compared with two groups of MAP,HR,SpO_2,VAS score,Ramsay score. Compared with two groups of effective pressing times,fentanyl dose and adverse reactions. Results In the observation group,the effective pressing times and the dose of 48 h fentanyl were significantly lower than those of the control group. The difference was statistically significant（ P〈0. 05）. The observation group 1,6,12,24 hours of MAP,HR was significantly lower than the control group. The difference was statistically significant（ P〈0. 05）. There was no significant difference in SpO_2 levels between the two groups at each time point（ P〈0. 05）. After 1,6,12 and 24 hours,the VAS score of the observation group was significantly lower than that of the control group,the Ramsay score was significantly higher than that of the control group. The difference was statistically significant（ P〈0. 05）. The incidence rate of adverse reaction in the observation group（ 8. 11%） was significantly higher than that in the control group（ 29. 73%）. The difference was statistically significant（ χ^2= 5. 638,P〈0. 05）. Conclusion The effects of dexmedetomidine combined with fentanyl in patients undergoing upper abdominal surgery postoperative patient-controlled intravenous analgesia,and independent use than fentanyl,can achieve better analgesic and sedative effect,reduce the dose of fentanyl and the occurrence of adverse reactions,effectively.