摘要
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.
出处
《中国微创外科杂志》
CSCD
北大核心
2018年第1期6-10,共5页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔热灌注化疗
右旋美托咪定
舒芬太尼
患者静脉自控镇痛
Hyperthermic intraperitoneal chemotherapy
Dexmedetomidine
Sufentanil
Patients controlled intravenous analgesia