舒芬太尼复合右美托咪定对老年肿瘤切除患者术后镇痛效果、睡眠质量及应激反应的影响讨论

Effect of Sufentanil Combined with Dexmedetomidine on Postoperative Analgesia, Sleep Quality and Stress Response in Elderly Patients with Tumor Resection

目的舒芬太尼复合右美托咪定对老年肿瘤切除患者术后镇痛效果、睡眠质量及应激反应的影响观察。方法方便选择该医院2016年1月—2017年12月就诊胃肠肿瘤患者60例,按随机数表法分为两组,各30例。两组患者手术结束后启动镇痛泵,对照组镇痛泵采用舒芬太尼2μg/kg、托烷司琼5 mg,观察组在对照组基础上加用右美托咪定2μg/kg,镇痛泵设定:单次给药剂量为1 mL,锁定时间调节为15 min,连续给药2 mL/h。采用视觉模拟疼痛评分(VAS)、拉姆齐镇静评分(RSS)评估两组患者手术前后疼痛、镇静情况,检测两组患者手术前后血浆皮质醇(Cor)、肾上腺素(E)及去甲肾上腺素(NE)水平,检测患者手术前后睡眠效率、觉醒指数及主观睡眠质量评分,统计两组患者术后不良反应发生率。结果老年患者肿瘤切除术后24 h内,观察组VAS评分低于对照组[术后24 h评分(2.11±0.47)分vs(2.42±0.50)分],RSS评分高于对照组[术后24 h评分(1.44±0.33)分vs(1.17±0.30)分],差异有统计学意义(t=2.474、3.316,P<0.05);术后各时间段,观察组Cor、E、NE水平均低于对照组[术后48 h,Cor水平(385.55±42.11) ng/mL vs(422.58±43.04)ng/mL,E水平(0.61±0.06) nmol/L vs(0.68±0.07)nmol/L,NE水平(1.61±0.25) nmol/L vs(1.77±0.28)nmol/L],差异有统计学意义(t=3.823、4.159、2.335,P<0.05);术后2 d内,观察组觉醒指数低于对照组,睡眠效率、主观睡眠质量评分均高于对照组[术后2 d,睡眠效率(68.17±6.55)%vs(58.94±6.13)%,觉醒指数(8.13±0.88)vs(9.52±1.03),睡眠质量评分(6.68±0.69)分vs (5.77±0.59)分],差异有统计学意义(t=5.635、5.620、5.490,P<0.05);两组患者不良反应发生率(13.33%vs20.00%)差异无统计学意义(χ~2=0.120,P>0.05)。结论舒芬太尼复合右美托咪定在老年患者肿瘤切除术后镇痛效果较好,可改善睡眠质量,减少应激反应。

Objective To observe the effects of sufentanil combined with dexmedetomidine on postoperative analgesia,sleep quality and stress response in elderly patients with tumor resection.Methods 60 patients with gastrointestinal cancer were convenient selected and enrolled in the hospital from January 2016 to December 2017.They were divided into two groups according to the random number table method,30 cases each.The analgesic pumps were started after the operation of the two groups.The analgesic pump of the control group was sufentanil 2 μg/kg and tropisetron 5 mg.The observation group was given dexmedetomidine 2 μg/kg on the basis of the control group.Pain pump setting:single dose was 1 mL,lock time was adjusted to 15 min,continuous administration was 2 mL/h.Pain and sedation before and after surgery were evaluated by visual analogue pain score (VAS) and Ramsey sedation score (RSS),Plasma cortisol (Cor),epinephrine (E) and norepinephrine were measured before and after surgery.The level of hormone (NE) was used to detect sleep efficiency,arousal index and subjective sleep quality score before and after surgery.The incidence of postoperative adverse reactions in the two groups was statistically analyzed.Results Within 24 hours after tumor resection in elderly patients,the VAS score of the observation group was lower than that of the control group [24 h postoperative score (2.11±0.47) points vs.(2.42±0.50) points],and the RSS score was higher than the control group [24 h after surgery the scores were (1.44±0.33) points and vs.(1.17±0.30) points].The difference was statistically significant (t=2.474,3.316,P<0.05).The postoperative Cor,E,and NE levels were lower in the observation group.Control group [48 h after surgery,Cor level (385.55±42.11) ng/mL vs (422.58±43.04) ng/mL,E level (0.61±0.06) nmol/L vs (0.68±0.07) nmol/L,NE level (1.61±0.25) nmol/L vs (1.77±0.28) nmol/L],the difference was statistically significant (t=3.823,4.159,2.335,P<0.05);within 2 days after surgery,the observation group had lower arousal index.In the control group,the sleep efficiency and subjective sleep quality scores were higher than those in the control group [2 days after surgery,sleep efficiency (68.17±6.55)% vs (58.94±6.13)%,arousal index (8.13±0.88) vs (9.52±1.03).The sleep quality score (6.68±0.69)points was vs.(5.77±0.59) points],the difference was statistically significant (t=5.635,5.620,5.490,P<0.05);the incidence of adverse reactions in the two groups (13.33% vs20.00%) The difference was not statistically significant (χ^2=0.120,P>0.05).Conclusion Sufentanil combined with dexmedetomidine is effective in analgesia after tumor resection in elderly patients,which can improve sleep quality and reduce stress response.