舒芬太尼联合右美托咪定在心脏术后患者镇痛镇静中的应用

Application of sufentanil combined with dexmedetomidine on analgesia and sedation for the patients undergoing cardiac surgery

目的:探讨舒芬太尼联合右美托咪定对心脏外科术后患者镇痛镇静的安全性和有效性。方法:选择2018年1—12月,甘肃省人民医院重症加强护理病房(intensive care unit, ICU)收住的120例心脏术后患者,按随机数字表法分为舒芬太尼组(A组)和舒芬太尼联合右美托咪定组(B组),每组60例。2组患者术中均进行低温体外循环全身麻醉,术后入ICU。A组给予舒芬太尼,B组给予舒芬太尼联合右美托咪定镇痛镇静。观察2组患者用药前,用药后2、6、12、24 h疼痛和镇静评分、收缩压、舒张压、心率、呼吸频率、脉搏血氧饱和度、平均动脉压、24 h医护人员满意度评分及不良反应发生率。结果:2组患者在用药后各时间点的镇静程度评估表评分均较组内用药前降低,差异均有统计学意义(P<0.05);用药后2、6、12、24 h的视觉模拟评分B组均明显低于A组,差异均有统计学意义(P <0.05);但2组间及组内在用药前、用药后2、6、12、24 h各时间点的生命体征HR、MAP、RR、SpO_2比较,差异均无统计学差异(P>0. 05)。A组发生呼吸抑制的不良反应高于B组,医护人员满意度评分B组高于A组,差异均有统计学意义(P<0.05)。结论:对于心脏外科术后患者,舒芬太尼联合右美托咪定镇痛镇静应用于患者安全有效,无明显不良反应。

Objective: To investigate the safety and effectiveness of sufentanil combined with dexmedetomidine in analgesia and sedation for patients after cardiac surgery. Methods : A total of 120 patients who underwent cardiac surgery in department of intensive care unit(ICU), Gansu Provincial Hospital from January 2018 to December 2018 were randomly divided into the sufentanil group(group A) and sufentanil combined with dexmedetomidine group(group B), according to random number tablet, with 60 cases in each group. General anesthesia under hypothermic cardiopulmonary bypass was performed in both groups, and ICU was administered after operation. Group A was given sufentanil and group B was given sufentanil combined with dexmedetomidine for analgesia and sedation. The pain and sedation scores, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, pulse oxygen saturation, mean arterial pressure, 24 hours satisfaction score of medical staff and incidence of adverse reactions at 2, 6, 12 h after treatment and before treatment were observed, respectively. Results: After treatment, the scores of richmond agitation-sedation scale in 2 groups both decreased significantly compared to before treatment, the differences were statistically significant(P <0. 05). The scores of visual analogue scale in group B decreased significantly compared to group A at 2, 6, 12, 24 h after treatment, the differences were statistically significant(P <0. 05). There was no statistical significance between 2 groups, and between before and 2, 6, 12, 24 h after treatment for general indicator, respectively, including MAP, HR, RR, Sp02(P >0. 05). For the incidence of adverse drug reaction between 2 groups, respiratory depression rate in group A was significantly higher than group B(P <0. 05). The adverse reaction of respiratory depression in group A was higher than that in group B, and the satisfaction score of medical staff in group B was higher than that in group A, the difference was statistically significant(P <0.05). Conclusion: Sufentanil combined with dexmedetomide is safe and effective for analgesia and sedation patients with cardiac surgery, which without obvious adverse reactions.