右美托咪定联合舒芬太尼、地佐辛用于帕金森病患者下腹或下肢术后镇痛的临床研究

The analgesia effects of dexmedetomidine combined with sufentanil and dezocine for the patients with Parkinson’s disease after operation of lower abdomen or lower limb

目的观察并探讨右美托咪定联合舒芬太尼、地佐辛在帕金森病患者行下腹和下肢手术术后镇痛效果及对帕金森病患者短期认知功能的影响。方法选择在全凭静脉麻醉下行开放性下腹或下肢手术的帕金森病患者54例,依据PCIA泵配方随机分入2组:舒芬太尼200μg+地佐辛15 mg+托烷司琼6 mg+0.9%氯化钠溶液稀释至150 ml(S组)和舒芬太尼200μg+地佐辛15 mg+托烷司琼6 mg+右美托咪定200μg+0.9%氯化钠溶液稀释稀释至150 ml(D组)。2组均于术前1 d分别使用简易精神状态检查表(MMSE)和视觉模拟疼痛评分表(VAS)测量认知功能和疼痛水平。PCIA泵参数均设置为背景剂量2.0 ml/h,冲击剂量1.5 ml,锁定15 min。记录术后4、24、48 h静息状态的VAS、镇静(Ramsay)评分和48 h内PCIA泵使用药物总量、PCIA泵总按压次数及术后3、5、7 d MMSE评分。结果术后24、48 h,S组VAS评分明显高于D组(P<0.05);S组PCIA泵药物消耗总量和患者术后静脉镇痛(PCIA)泵总按压次数明显高于D组(P<0.05)。术后24 h、48 h,D组Ramsay评分均高于S组。术后3、5、7 d,S组MMSE评分均低于D组(P<0.05),且2组各时点MMSE评分均低于同组术前1 d评分(P<0.05)。2组恶心、呕吐、皮肤瘙痒、SpO 2<90%、心动过缓等不良反应发生例数差异无统计学意义(P>0.05)。结论右美托咪定复合舒芬太尼、地佐辛用于帕金森病患者术后静脉镇痛可显著降低术后疼痛,减少镇痛药物的使用量,并可改善短期认知功能。

Objective To observe the analgesia effects of dexmedetomidine combined with sufentanil and dezocine for the patients with Parkinson’s disease after operation of lower abdomen or lower limb,and to investigate their effects on short-term cognitive function of patients.Methods A total of 54 patients with Parkinson’s disease who underwent openness surgery of lower abdomen or lower limb under total intravenous anesthesia were enrolled in the study,who were divided into two groups according to patient controlled intravenous analgesia(PCIA)pump formulas:group S(sufentanil 200μg+dezocine 15mg+tropisetron 6mg,diluted by 0.9%normal saline into 150ml)and group D(sufentanil 200μg+dezocine 15mg+tropisetron 6mg+dexmedetomidine 200μg,diluted by 0.9%normal saline into 150ml).The cognitive functions and pain levels at 1 day before operation were measured by means of mini mental state examination(MMSE)and VAS in both groups,and PCIA pump parameters were set as background dose of 2ml/h,and bolus dose of 1.5ml,and lockout time of 15 minutes.Moreover the scores of VAS and Ramsay at 4h,24h and 48h after operation in quiescent status,and the total PCIA pump medication dosage within 48h,and the total times of pressing PCIA pump as well as MMSE scores at 3d,5d and 7d after operation were observed and compared between the two groups.Results The VAS scores at 24h and 48h after operation in group S were significantly higher than those in group D(P<0.05).The total PCIA pump medication dosage and the total times of pressing PCIA pump in group S were significantly higher than those in group D(P<0.05).The Ramsay scores at 24h,48h after operation in group D were significantly higher than those in group S.The MMSE scores at 3d,5d,7d after operation in group S were significantly lower than those in group D(P<0.05).Moreover the MMSE scores in both groups at different time points after operation were significantly lower than those at 1d before operation(P<0.05).There were no significant differences in the incidence rates of adverse reactions including nausea,vomiting,cutaneous pruritus,SpO 2<90%,bradycardia between the two groups(P>0.05).Conclusion The dexmedetomidine combined with sufentanil and dezocine can significantly relieve the postoperative pain for the patients with Parkinson’s disease after operation,which can reduce the application amount of analgesics,improve short-term cognitive function of patients.