羟考酮复合右美托咪定用于三叉神经痛患者微血管减压术后镇静镇痛

Postoperative sedation and analgesia of oxycodone combined with dexmedetomidine in patients with trigeminal neuralgia undergoing microvascular decompression

目的评估羟考酮复合右美托咪定用于三叉神经痛患者微血管减压术后镇静镇痛的效果。方法选择2014年5月至2015年5月解放军总医院附属第一医院择期三叉神经痛微血管减压术患者60例,采用随机数字表法将患者分为对照组(C组)和羟考酮复合右美托咪定组(D组),每组30例。术后行患者自控静脉镇痛(PCIA)。C组采用羟考酮0.8 mg/kg+雷莫司琼0.6 mg;D组采用羟考酮0.8 mg/kg+右美托咪定0.05μg/(kg·h)+雷莫司琼0.6 mg,两组均用生理盐水稀释至100 m L。记录患者术后4 h、12 h、24 h和48 h的平均动脉压(MAP)、心率(HR),并进行疼痛、镇静、睡眠质量评分,记录不良反应发生率,术后第3天评价患者满意度。结果 D组患者术后4 h、12 h、24 h和48 h的MAP分别为(85.8±4.8)mm Hg、(84.0±3.8)mm Hg、(82.1±4.0)mm Hg、(82.6±3.6)mm Hg,与C组[(89.1±6.2)mm Hg、(87.3±5.6)mm Hg、(85.2±5.9)mm Hg、(85.4±5.4)mm Hg]比较差异均有统计学意义(P<0.05);术后各时点的HR值D组分别为(66.5±6.5)次/min、(64.5±6.0)次/min、(64.8±5.6)次/min、(64.2±6.2)次/min,与C组[(70.9±8.4)次/min、(71.0±7.7)次/min、(69.8±7.5)次/min、(69.6±6.7)次/min]比较差异均有统计学意义(P<0.05);术后各时间点VAS评分D组分别为(2.0±0.5)分、(1.4±0.6)分、(1.0±0.5)分、(0.7±0.5)分,与C组[(2.4±0.7)分、(1.8±0.8)分、(1.4±0.7)分、(1.1±0.6)分]比较差异均有统计学意义(P<0.05);各时点Ramsay镇静评分D组分别为(3.1±0.6)分、(2.9±0.6)分、(2.3±0.5)分、(2.3±0.5)分,与C组[(2.2±0.6)分、(2.4±0.6)分、(2.0±0.5)分、(2.0±0.3)分]比较差异均有统计学意义(P<0.05);两组患者术后48 h内睡眠质量评分D组0分比例明显增多,差异有统计学意义(P<0.05)。与C组(8例)比较,D组发生恶心、呕吐2例,两组差异有统计学意义(P<0.05)。两组患者均未发生心动过缓、呼吸抑制及镇静过度。术后第3天随访D组患者对PCIA满意度为24例(80.0%),C组10例(33.3%),两组差异有统计学意义(P<0.05)。结论羟考酮复合右美托咪定用于三叉神经痛患者微血管减压术后PCIA,可提供良好的镇静镇痛效果,降低恶心、呕吐发生率,提高围术期患者满意度。

Objective To evaluate the effects of oxycodone combined with dexmedetomidine on postoperative sedation and analgesia in patients with trigeminal neuralgia undergoing microvascular decompression. Methods Sixty patients with trigeminal neuralgia scheduled for microvascular decompression in our hospital from May 2014 to May2015 were randomly divided into two groups to receive oxycodone 0.8 mg/kg＋dexmedetomidine 1 μg/（kg· d）＋ramosetron 0.6 mg（group D, n=30） and oxycodone 0.8 mg/kg＋ramosetron 0.6 mg（control group/group C, n=30）, with saline added to 100 m L. Patient-controlled intravenous analgesia（PCIA） was performed after operation. At 4 h, 12 h, 24 h, and48 h postoperatively, mean arterial pressure（MBP）, heart rate（HR）, pain and sedation scores were recorded. The sleep quality score and incidence of side effects were also recorded. The patients＇ satisfaction degree was evaluated on the 3rd day postoperatively. Results MAP in group D were（85.8±4.8） mm Hg,（84.0±3.8） mm Hg,（82.1±4.0） mm Hg,（82.6±3.6） mm Hg at 4 h, 12 h, 24 h and 48 h postoperatively, as compared with（89.1±6.2） mm Hg,（87.3±5.6） mm Hg,（85.2±5.9） mm Hg,（85.4±5.4） mm Hg in group C（P〈0.05）. HR in group D were（66.5±6.5） beats/min,（64.5±6.0） beats/min,（64.8±5.6） beats/min,（64.2±6.2） beats/min at 4 h, 12 h, 24 h and 48 h postoperatively, as compared with（70.9±8.4）beats/min,（71.0±7.7） beats/min,（69.8±7.5） beats/min,（69.6±6.7） beats/min in group C（P〈0.05）. The VAS scores at the four time points were（2.0±0.5）,（1.4±0.6）,（1.0±0.5）,（0.7±0.5） in group D, versus（2.4±0.7）,（1.8±0.8）,（1.4±0.7）,（1.1±0.6） in group C（P〈0.05）. The Ramsay scores in group D were（3.1±0.6）,（2.9±0.6）,（2.3±0.5）,（2.3±0.5）, versus（2.2±0.6）,（2.4±0.6）,（2.0±0.5）,（2.0±0.3） in group C（P〈0.05）. The patients with 0 in sleeping score in group D were significantly more than those in group C at 48 h postoperatively（P〈0.05）, and the incidence of nausea and vomiting were significantly lower in group D（2 cases） than in group C（8 cases）（P〈0.05）. There was no bradycardia, respiratory depression and over-sedation in the two groups. on the 3rdday postoperatively, satisfaction rate of patients on PCIA in group D（24 cases, 80.0%） were significantly better than that of control group（10 cases, 33.3%）（P〈0.05）. Conclusion Application of oxycodone combined with dexmedetomidine in postoperative PCIA for patients with trigeminal neuralgia undergoing microvascular decompression can achieve satisfied sedative and analgesic effect, reduce incidence of nausea and vomiting, and improve the satisfaction rate of patients.