右美托咪定复合芬太尼在晚期癌痛IDDS植入手术中的应用

The application of dexmedetomidine combined with fentanyl in patients suffering with advanced cancer pain undergoing IDDS implantation surgery

目的:探讨右美托咪定在晚期癌痛鞘内药物输注系统(intrathecal drug delivery systems,IDDS)植入手术中镇静、镇痛的有效性及安全性。方法:选择行IDDS手术的晚期癌痛患者40例,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级,随机数字法分为2组:右美托咪定联合芬太尼组(Dex组,n=20)和单用芬太尼组(Fen组,n=20)。Dex组在手术开始前10 min内共静脉泵入右美托咪定0.5μg/kg,后以0.2~0.5μg/(kg·h)右美托咪定持续泵注至术毕。Fen组泵入等容量生理盐水。两组术前5 min均静注芬太尼1μg/kg。术中依据患者视觉模拟评分(visual analogue score,VAS)间断静注芬太尼。记录入室时(T_0),手术开始时(T_1),手术开始后15 min(T_2)、30 min(T_3)、45 min(T_4)、60 min(T_5)、75 min(T_6)、90 min(T_7),术毕(T_8),入麻醉后监测治疗室(PACU)15 min(T_9),入PACU 30 min(T_(10))等时间点的平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O_2)、VAS评分以及Ramsay镇静评分。同时记录两组恶心呕吐、呼吸抑制等并发症的发生情况,以及芬太尼用量、手术时间、患者完全恢复时间、患者满意度评分等。结果:与Fen组相比,Dex组MAP在T_2、T_3时降低,HR在T_2~T_8时减慢,Sp O2在T_2~T_8时升高,VAS评分在T_3~T_5、T_7~T_(10)均降低,Ramsay镇静评分在T_1~T_(10)均升高(P<0.05)。与Fen组相比,Dex组芬太尼用量减少,患者满意度评分升高(P<0.05)。结论:右美托咪定复合芬太尼能安全地用于晚期癌痛行IDDS手术的患者,可获得良好的镇静、镇痛作用,并能节省芬太尼用量,提高患者满意度。

Objective：To explore the efficacy and safety of dexmedetomidine in sedation and analgesia during implantation of intrathecal drug infusion system（IDDS）for patients with advanced cancer pain. Methods：A total of 40 patients with advanced cancer pain classified as ASAⅡ-Ⅲ scheduled for IDDS implantation surgery were randomly assigned to two groups：the dexmedetomidine combined with fentanyl group（the Dex group,n=20）and the single fentanyl group（the Fen group,n=20）. In the Dex group,patients were infused with dexmedetomidine at a loading dose of 0.5 μg/kg within 10 min before operation,followed by a maintenance infusion of 0.2-0.5 μg/（kg·h）until the end of surgery. Patients in the Fen group were infused with equal volume of normal saline. All patients received 1 μg/kg fentanyl intravenously 5 minutes before operation. During the operation,fentanyl was intermittently injected according to patients＇ visual analogue score（VAS）scores. MAP,HR,SpO2,VAS and Ramsay scores were measured and recorded for this study at T0（after entering operation room）,T1（the beginning of operation）,T2-T7（operation for 15 min,30 min,45 min,60 min,75 min and 90 min）,T8（the end of operation）,T9（15 min after arrival at PACU）and T（10）（30 min after arrival at PACU）. The incidences of side effects（nausea,vomiting,respiratory depression,etc.）,fentanyl consumption,time to full recovery and patient satisfaction scores were also recorded. Results：Compared with the Fen group,the MAP was significantly lower in the Dex group at T2 and T3（P〈0.05）. In the Dex group,HR was significantly lower at T2-T8,whereas Sp O2 was higher at the same time points mentioned above（P〈0.05）. VAS scores were significantly lower in the Dex group compared with the Fen group at T3-T5 and T7-T（10）,whereas Ramsay scores were significantly higher at T1-T（10）（P〈0.05）. Compared with the Fen group,patients required less fentanyl consumption and acquired higher satisfaction scores in the Dex group（P〈0.05）. Conclusion：Dexmedetomidine combined with fentanyl can be safely used in patients with advanced cancer pain for IDDS implantation surgery,which can achieve better sedation and analgesic effect,less fentanyl consumption and higher satisfaction scores.