右美托咪定复合舒芬太尼对结肠癌术后镇痛效果及炎性反应的影响

The Influence of Dexmedetomidine Combined with Sufentanil on the Postoperative Analgesia Efficacy and Inflammatory Reaction

目的探讨右美托咪定复合舒芬太尼对结肠癌术后镇痛效果及炎性反应的影响。方法选择我院行结肠癌根治术的90例患者,随机分为对照组、D1、D2三组,三组给予相同的麻醉方式,但采取不同的自控镇痛方式。观察三组在术毕(T1)、术后4 h(T2)、8 h(T3)、24 h(T4)的VAS、Ramsay评分、术后48h的不良反应,并检测三组患者T1及术后T4时间点的IL-6及TNF-α水平。结果对照组、D1组与D2组在T2、T3、T4点的VAS评分显著低于T1点,而D1、D2组在T2、T3、T4点的VAS评分明显较对照组在同时间点的低,P均<0.05,D1、D2组间对比无统计学意义;与T1点对比,D1组、D2组在T2、T3、T4点的Ramsay评分明显较高,D1、D2组在T2、T3、T4点的Ramsay评分明显较对照组同时间点高,P均<0.05;D2组T4点的Ramsay评分明显高于D1组;D1、D2组在T4点的IL-6及TNF-α水平均明显低于T1点,D1、D2组的IL-6、TNF-α水平明显低于对照组,D2组的IL-6及TNF-α水平明显低于D1组,P均<0.05。对照组恶心呕吐发生率明显高于D1及D2组,D1组明显高于D2组;对照组心动过缓发生率明显低于D1、D2组,P均<0.05,D1、D2组间对比差异无统计学意义。结论结肠癌术后应用1.5μg/(kg·d)右美托咪定镇痛效果良好,且可更有效地减少术后恶心呕吐不良反应,但会增加患者心动过缓的发生率,应及时给予相应的治疗。

Objective To investigate the influence of dexmedetomidine combined with sufentanil on postoperative anal -gesia efficacy and inflammatory reaction.Methods 90 cases of colon carcinoma treated with radical operation were chosen and randomly divided into the control group ,D1 and D2 group.The 3 groups were given same way of anesthesia and different ways of self-control analgesia.The VAS、Ramsay score at end of operation （T1）,after surgery for 4h（T2）,8h（T3）and 24h（T4）were ob-served,the adverse reactions after surgery for 48h were observed.The IL-6 and TNF-αat T1 and T4 were detected.Results The VAS score of D1 and D2 group at T2、T3、T4 were obvious lower than T1,while the VAS score of D1、D2 group at T2、T3、T4 were significant lower than the control group ,P〈0.05,which at D1 and D2 groups had no significant difference.The Ramsay score of D1 and D2 groups at T2、T3、T4 were higher than T1,while which were higher than the control group than the control group ,P〈0.05.The Ramsay score of D2 group at T4 was obvious higher than D1,the IL-6 and TNF-αof D1、D2 at T4 were obvious lower than T1.The IL-6、TNF-αof D1、D2 groups were significant lower than the control group ,the IL-6 and TNF-αof D2 group were lower than D1 group,P〈0.05.The nausea and vomiting incidence of the control group were higher than D 1and D2 groups,the D1 group was higher than D2 group,the bradycardia incidence of control group were lower than D 1、D2 groups,P〈0.05,which at D1 and D2 groups had no significant difference.Conclusion The 1.5μg/（kg.d）Dexmedetomidine after colorectal cancer postoper-ative had great analgesic efficacy ,which had effectively decrease the adverse reaction of nausea＆amp;vomiting ,which could increase the bradycardia incidence ,and should be given corresponding treatment.