地佐辛联合右美托咪定在肾移植术后镇痛镇静中的效果及对患者肾功能的影响

Effect of Dezocine combined with Dexmedetomidine on the analgesia, sedation and renal function after renal transplantation

目的探究地佐辛联合右美托咪定在肾移植术后镇痛镇静中的效果及对患者肾功能的影响。方法选取中国人民解放军联勤保障部队第九二四医院2015年6月至2018年6月收治的拟行肾移植手术的70例患者纳入此次前瞻性对照研究。采用随机数表法将入选患者分为观察组和对照组,每组各35例,均给予右美托咪定硬膜外自控镇痛,观察组患者麻醉药物加用地佐辛。采用视觉模拟评分法(visual analogue scale,VAS)评分、Ramsay镇静评分评价两组患者镇痛镇静效果;检测两组患者围术期血尿素氮(blood urea nitrogen,BUN)、肌酐(creatinine,Cr)水平及内生肌酐清除率(creatinine clearance rate,Ccr)变化,分析两种镇痛方案对患者肾功能的影响。结果两组患者手术时间、术中平均泌尿时间、术中输液量比较均无显著差异(P_均> 0.05)。术后6、12、24、48 h,观察组患者VAS评分均显著低于对照组(P_均<0.05),Ramsay评分均显著高于对照组(P_均<0.05)。术后24、48、72 h,两组患者BUN、Cr水平均显著低于本组麻醉前(P_均<0.05),Ccr均显著高于本组麻醉前(P_均<0.05)。术后24、48、72 h,观察组患者BUN、Cr水平均显著低于同期对照组(P_均<0.05),Ccr均显著高于同期对照组(P_均<0.05)。两组患者不良反应发生率比较无显著差异(χ~2=0.215,P=0.643)。结论地佐辛联合右美托咪定硬膜外自控镇痛效果良好,且能够在不加剧镇静深度的前提下保证镇痛的安全性,促进患者肾功能的恢复。

Objective To explore the effect of Dezocine combined with Dexmedetomidine on the analgesia and sedation after kidney transplantation and its influence on renal function of patients.Method 70 cases of renal transplantation patients admitted to the 924th Hospital of PLA from June 2015 to June 2018 were included in the prospective control study.The patients were divided into observation group and control group by random number table,35 cases in each group.All patients were given Dexmedetomidine for epidural analgesia.Observation group patients were given Dezocine plus anesthetics.The visual analogue scale(VAS)and Ramsay sedation score were used to evaluate the analgesic and sedative effects of the two groups.Perioperative changes of blood urea nitrogen(BUN),creatinine(Cr)levels and creatinine clearance rate(Ccr)in the two groups were detected,and the effects of the two analgesic schemes on renal function were analyzed.Result There was no significant difference in operation time,mean urinary time during operation and intraoperative infusion volume between the two groups(Pall>0.05).At 6,12,24 and 48 hours after operation,the VAS score of observation group was lower than that of control group(Pall<0.05),and the Ramsay score was higher than that of control group(Pall<0.05).At 24,48 and 72 hours after operation,BUN and Cr levels in both groups were significantly lower than those before anesthesia(Pall<0.05),and Ccr were significantly higher than those before anesthesia(Pall<0.05).At 24,48 and 72 hours after operation,BUN and Cr levels in observation group were significantly lower than those in control group(Pall<0.05),and Ccr were significantly higher than those in control group(Pall<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(χ^2=0.215,P=0.643).Conclusion The patient-controlled epidural analgesia with Dezocine and Dexmedetomidine is effective,and can ensure the safety of analgesia without aggravating the depth of sedation and promote the recovery of renal function.