右美托咪定联合舒芬太尼对胃肠道肿瘤患者术后镇痛时效的观察

Clinical Observation of Dexmedetomidine Combined with Sufentanil on Postoperative Analgesia in Patients with Gastric Cancer

目的观察右美托咪定联合舒芬太尼对胃肠道肿瘤患者术后镇痛时效的延长作用。方法选择胃肠外科手术患者60例,根据入院先后顺序分为两组,舒芬太尼组(S组)、右美托咪定联合舒芬太尼组(DS组)。2组患者术后均用PCIA泵(100 ml),设置均为:背景剂量2 ml/h(S组,舒芬太尼0.04μg·kg^(-1)·h^(-1);DS组,右美托咪定0.1μg·kg^(-1)·h^(-1)+舒芬太尼0.04μg·kg^(-1)·h^(-1));单次剂量为0.5 ml,锁定时间15 min,对比两组术后3 h、6 h、12 h、24 h、48h、72 h、96 h患者的VAS评分、Ramsay镇静评分、48 h PCIA有效按压次数,同时观察患者术后恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应及患者满意度。结果术后3 h、6 h、12 h、24 h、48 h、72 h、96 h两组MAP、HR、SPO2、RR比较,差异无统计学意义(P>0.05);术后3 h、6 h、12 h、24 h、48 h DS组VASr低于S组,咳嗽时VASm明显低于S组,P<0.05;术后72 h、96 h DS组患者VASr、VASm显著低于S组(P<0.05);术后3 h、6 h、12 h、24 h、48 h、72 h、96 h的Ramsay镇静评分明显高于S组(P<0.05);48 h内镇痛泵的按压次数DS组较S组减少(P<0.05)。两组术后不良反应发生率对比差异无统计学意义(P>0.05),DS组患者满意度明显高于S组。结论患者术后采用右美托咪定联合舒芬太尼PCIA镇痛,安全有效,可延长术后镇痛作用时间,减少患者按压次数,患者满意度高,值得临床推广应用。

Objective To observe the effect of dexmedetomidine combined with sufentanil on postoperative analgesia in patients with gastric cancer.MethodsSelect the ASA class I or II undergoing gastrointestinal surgery（colorectal carcinoma,gastric cancer,60 patients）,postoperative patients voluntarily received intravenous analgesia treatment.According to admission order,they were divided into 2 groups：sufentanil group（group S）,dexmedetomidine combined with sufentanil group（group DS）.The patients in the 2 groups were treated with PCIA pump（100 ml）after surgery,The PCIA pump parameters were as follow：background dose was 2ml/h（group,Sufentanil 0.04μg·kg^（-1）·h^（-1）;group DS,Dexmedetomidine 0.1μg·kg^（-1）·h^（-1）＋Dufentanil 0.04μg·kg^（-1）·h^（-1））;the single dose was 0.5ml,lock time was 15min.The 48h press times,the VAS,and Ramsay sedation score after surgery for 3h,6h,12h,24h,48h,72h and 96h were recorded.The adverse reactions and patient satisfaction of the 2groups were compared.Results There was no significant difference between the the 2 groups in MAP、HR、SPO2、RR at 3 h,6h,12 h,24 h,48 h,72 h,96 h after operation（P0.05）.The VASr of group DS was lower than that of S group at 3h,6h,12h,24h and 48h after operation,VASm was significantly lower in cough than that in group S;the VASr and VASm of group DS were significantly lower than those of S group at 72 h and 96 h after operation;The Ramsay sedation score at 3h,6h,12h,24h,48h,72h and 96h was significantly higher than that of group S;The 48h PCIA press times in group DS was reduced than that in the group S（P0.05）.The adverse reactions of the 2 groups had no significant differences（P0.05）,the stratification of group DS was higher than group S.ConclusionThe postoperative PCIA analgesia of dexmedetomidine combined with sufentanil can prolong the time of postoperative analgesic effect,reduce the patients pressed times,and it is worthy of clinical promotion.