舒芬太尼复合右旋美托咪定用于腹腔热灌注化疗术后患者镇痛的效果观察

Sufentanil Combined With Dexmedetomidine for Analgesia After Hyperthermic Intraperitoneal Chemotherapy

目的观察舒芬太尼复合右旋美托咪定用于腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPC)术后患者镇痛的临床效果。方法选择ASAⅠ~Ⅱ级择期行HIPC 45例,采用随机数字表随机均分为3组,术后使用患者静脉自控镇痛(patients controlled intravenous analgesia,PCIA),背景剂量2 ml/h,按压剂量2 ml/次,负荷量2 ml,锁定时间15min,药液量100 ml,舒芬太尼3.0μg/h(A组)、舒芬太尼2.0μg/h(B组)、舒芬太尼2.0μg/h+右旋美托咪定4.0μg/h(C组)。观察并记录术后即刻1 h(T1)、2 h(T2)、6 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)患者镇痛评分(VAS)、Ramsay镇静评分,PCIA泵按压次数及不良反应。结果 A、C组T3~T6时点VAS评分明显低于B组[T3:(2.9±0.5)分vs.(3.5±0.8)分,q=3.600,P<0.05;(2.8±0.6)分vs.(3.5±0.8)分,q=4.200,P<0.05。T4:(2.4±0.6)分vs.(2.9±0.7)分,q=3.049,P<0.05;(2.3±0.6)分vs.(2.9±0.7)分,q=3.659,P<0.05。T5:(1.9±0.6)分vs.(2.5±0.5)分,q=3.838,P<0.05;(1.8±0.7)分vs.(2.5±0.5)分,q=4.477,P<0.05。T6:(1.6±0.5)分vs.(2.0±0.4)分,q=3.303,P<0.05;(1.5±0.5)分vs.(2.0±0.4)分,q=4.129,P<0.05]。A组T5、T6时点Ramsay评分明显高于B组[T5:(2.5±0.5)分vs.(2.1±0.5)分,q=2.893,P<0.05;T6:(2.3±0.5)分vs.(1.9±0.3)分,q=3.493,P<0.05]。B组T3~T6时点Ramsay评分明显低于C组[T3:(2.4±0.5)分vs.(3.1±0.7)分,q=4.477,P<0.05;T4:(2.2±0.4)分vs.(2.8±0.7)分,q=4.243,P<0.05;T5:(2.1±0.5)分vs.(2.6±0.6)分,q=3.617,P<0.05;T6:(1.9±0.3)分vs.(2.4±0.5)分,q=4.367,P<0.05]。恶心呕吐发生率A组明显高于C组[46.7%(7/15)vs.6.7%(1/15),χ~2=4.261,P=0.039],B、C组和A、B组无统计学差异(P>0.05)。A、C组48 h内按压次数明显少于B组[(5.3±2.6)次vs.(8.4±4.2)次,q=3.662,P<0.05;(4.5±2.8)次vs.(8.4±4.2)次,q=4.608,P<0.05]。结论右美托咪定用于HIPC术后患者镇痛可减少舒芬太尼使用量,同时降低恶心呕吐发生率。

Objective To evaluate the analgesic efficiency of patients controlled intravenous analgesia（ PCIA） with sufentanil and dexmedetomidine after hyperthermic intraperitoneal chemotherapy（ HIPC）. Methods A total of 45 patients undergoing HIPC were randomly divided into 3 groups with 15 in each group. They received PCIA after operation with a background infusion rate of2 ml/h,a loading dose of 2 ml,a lockout time of 15 min,and a liquid volume of 100 ml. The PCIA formulation in each group was as follows： group A（ sufentanil 3. 0 μg/h）,group B（ sufentanil 2. 0 μg/h）,and group C（ sufentanil 2. 0 μg/h ＋ dexmedetomidine4. 0 μg/h）. The VAS,Ramsay sedation scale,patient pressing times,and the adverse effects were recorded at 1 h（ T1）,2 h（ T2）,6 h（ T3）,12 h（ T4）,24 h（ T5）,and 48 h（ T6） after surgery. Results The VAS scores of the group B were higher than those in the other two groups at T3-T6 time points [T3：（ 2. 9 ± 0. 5） points vs.（ 3. 5 ± 0. 8） points,q = 3. 600,P 〈 0. 05,（ 2. 8 ± 0. 6）points vs.（ 3. 5 ± 0. 8） points,q = 4. 200,P 〈 0. 05; T4：（ 2. 4 ± 0. 6） points vs.（ 2. 9 ± 0. 7） points,q = 3. 049,P 〈 0. 05;（ 2. 3 ±0. 6） points vs.（ 2. 9 ± 0. 7） points,q = 3. 659,P 〈 0. 05; T5：（ 1. 9 ± 0. 6） points vs.（ 2. 5 ± 0. 5） points,q = 3. 838,P 〈 0. 05;（ 1. 8 ± 0. 7） points vs.（ 2. 5 ± 0. 5） points,q = 4. 477,P 〈 0. 05; T6：（ 1. 6 ± 0. 5） points vs.（ 2. 0 ± 0. 4） points,q = 3. 303,P 〈0. 05;（ 1. 5 ± 0. 5） points vs.（ 2. 0 ± 0. 4） points,q = 4. 129,P 〈 0. 05]. The Ramsay scores of the group A were statistically higher than those of the group B at T5 and T6 [T5：（ 2. 5 ± 0. 5） points vs.（ 2. 1 ± 0. 5） points,q = 2. 893,P 〈 0. 05; T6：（ 2. 3 ± 0. 5）points vs.（ 1. 9 ± 0. 3） points,q = 3. 493,P 〈 0. 05]. The Ramsay scores of the group B were statistically lower than those of the group C at T3-T6 [T3：（ 2. 4 ± 0. 5） points vs.（ 3. 1 ± 0. 7） points,q = 4. 477,P 〈 0. 05; T4：（ 2. 2 ± 0. 4） points vs.（ 2. 8 ±0. 7） points,q = 4. 243,P 〈 0. 05; T5：（ 2. 1 ± 0. 5） points vs.（ 2. 6 ± 0. 6） points,q = 3. 617,P 〈 0. 05; T6：（ 1. 9 ± 0. 3） points vs.（ 2. 4 ± 0. 5） points,q = 4. 367,P 〈 0. 05]. The incidence of nausea and vomiting in the group A was higher than that in the group C [7 cases（ 46. 7%） vs. 1 case（ 6. 7%）,χ~2= 4. 261,P = 0. 039],while there were no differences between group B and C and between group A and B（ P 〉 0. 05）. The number of pressing times in the group B was more than that in the other two groups[（ 5. 3 ± 2. 6） times vs.（ 8. 4 ± 4. 2） times,q = 3. 662,P 〈 0. 05;（ 4. 5 ± 2. 8） times vs.（ 8. 4 ± 4. 2） times,q = 4. 608,P 〈0. 05]. Conclusion Dexmedetomidine can reduce postoperative consumption of sufentanil in patients undergoing HIPC and decrease the incidence of nausea and vomiting.