右美托咪定复合酮咯酸氨丁三醇超前镇痛对腹腔镜胃癌根治患者术后镇痛的影响

Effect of preemptive analgesia of dexmedetomidine combined with ketorolac on postoperative analgesia in patients undergoing laparoscopic radical gastrectomy

目的:观察右美托咪定复合酮咯酸氨丁三醇超前镇痛对腹腔镜胃癌患者术后镇痛的影响。方法:收集择期行腹腔镜胃癌根治手术患者90例,ASAⅠ~Ⅱ级,随机分为3组,右美托咪定(Dex)组(D组)30例、酮咯酸氨丁三醇(Ket)组(K组)30例和Dex复合Ket组(DK组)30例。D组在全麻诱导前静脉泵注Dex0.5μg/(kg·h),泵注时间为10min,然后以0.3μg/(kg·h)的速度持续泵注,直至手术结束前30min停;K组在手术开始前10min静脉注射Ket0.5mg/kg;DK组分别按照D组和K组的方法注射Dex和Ket。术毕3组均给予自控静脉镇痛泵(PCIA),配方为舒芬太尼2μg/kg+昂丹司琼8mg,稀释至100mL,负荷量为5mL,背景剂量2mL/h,追加量0.5mL,锁定时间15min。记录3组患者术后0h(T1)、2h(T2)、6h(T3)、12h(T4)、24h(T5)、48h(T6)的静息痛及活动痛的视觉模拟(VAS)评分、拉姆齐镇静(RSS)评分;记录3组患者术后不良反应(恶心、呕吐、头晕、低血压、心动过缓及呼吸抑制)和总体满意度;记录3组患者术后48h内镇痛泵有效按压次数、镇痛急救措施次数、术后舒芬太尼使用总量(包括镇痛泵和镇痛急救使用)及术后肛门首次排气时间。结果:T1~T5时DK组静息痛VAS评分明显低于D组和K组(P<0.05);T1~T6时DK组活动痛VAS评分明显低于D组和K组(P<0.05);3组患者RSS评分比较差异无统计学意义(P>0.05);DK组术后48h内镇痛泵有效按压次数、镇痛急救措施次数、术后舒芬太尼使用总量及术后肛门首次排气时间均少于D组和T组,差异有统计学意义(P<0.05);与D组和K组比较,DK组恶心呕吐发生率明显降低,差异有统计学意义(P<0.05),DK组患者对术后总体满意度较高,差异有统计学意义(P<0.05)。结论:Dex复合Ket超前镇痛可明显减轻腹腔镜胃癌根治患者的术后疼痛,不仅减少术后舒芬太尼的用量,而且降低不良反应的发生率。

Objective:To evaluate the safety and efficacy of preemptive analgesia of dexmedetomidine combined with ketorolac on postoperative analgesia in patients undergoing laparoscopic radical gastrectomy.Methods:Ninety patients undergoing laparoscopic radical gastrectomy for gastric cancer were randomly divided into three groups(n=30):dexmedetomidine(Dex)group(D group),Ketorolac(Ket)group(K group)and Dex compound Ket group(DK group).Group D received intravenous injection of Dex 0.5μg/kg in 10 minutes before induction of general anesthesia,and then the infusion was continuously pumped at a rate of 0.3μg/(kg·h)until 30 minutes before the end of the operation.Ket 0.5 mg/kg was injected intravenously in group K at 10 minutes before operation.Dex and Ket were used in group DK according to the method of group D and group K respectively.All the three groups were given PCIA.The formulation was sufentanil 2μg/kg+ondansetron 8 mg,diluted to 100 mL,loaded to 5 mL,background dose 2 mL/h,additional dose 0.5 ml,locking time 15 min.Visual analogue scales(VAS)scores and Ramsay sedation scale(RSS)scores were recorded at 0 h(T1),2 h(T2),6 h(T3),12 h(T4),24 h(T5)and 48 h(T6)after operation in the three groups.Adverse reactions(nausea,vomiting,dizziness,respiratory depression,hypotension,bradycardia and deep sedation)and overall satisfaction were recorded in the three groups.The effective pressing times of analgesic pump,the number of emergency measures for analgesia,the total amount of sufentanil used(including analgesic pump and analgesic emergency use)and the first time of anal exhaust after operation were recorded.Results:The VAS score of resting pain in DK group at T1-T5 was significantly lower than that in D group and K group(P<0.05);the VAS score of active pain in DK group at T1-T6 was significantly lower than that in D group and K group(P<0.05);and There was no significant difference in RSS scores among the three groups(P>0.05).In DK group the effective pressing times of analgesic pump,the number of first aid measures,the total amount of sufentanil used after operation and the first time of anal exhaust after operation were significantly lower than those in D group and T group(P<0.05),and the incidence of nausea and vomiting in DK group was significantly lower than those in D group and K group(P<0.05),and the overall satisfaction of DK group was significantly grater than those in D group and K group(P<0.05).Conclusion:Dex combined with Ket preemptive analgesia can be safely and effectively used for postoperative analgesia in laparoscopic radical gastrectomy.It can not only reduce the dosage of sufentanil,but also reduce the incidence of adverse reactions.