右美托咪定复合布托啡诺在开腹肝部分切除患者术后镇痛的应用

Application of postoperative analgesia with combined use of dexmedetomidine and butorphanol in patients underwent partial hepatectomy by laparotomy

目的观察右美托咪定复合布托啡诺在开腹肝部分切除患者术后镇痛的应用效果。方法全身麻醉下行开腹肝部分切除术患者60例随机均分为两组:A组静脉患者自控镇痛(PCA)采用布托啡诺0.2 mg/kg+格拉司琼6 mg,B组采用布托啡诺0.15 mg/kg+右美托咪定2μg/kg+格拉司琼6 mg。记录患者术后2 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)静息和运动VAS疼痛评分及Ramsay镇静评分;记录术后48 h PCA泵按压总次数及镇痛补救率;记录术后不良反应发生率。结果与A组比较,T2~T4时B组静息VAS疼痛评分降低(P<0.05),T1~T5时B组运动VAS疼痛评分降低(P<0.05),T1~T4时B组Ramsay镇静评分降低(P<0.05)。术后48 h,B组PCA泵按压总次数为(2.3±0.4)次,少于A组的(7.8±1.1)次(P<0.05)。B组镇痛补救率为6.7%,低于A组的26.7%(P<0.05)。术后48 h,B组患者头晕、嗜睡、恶心、呕吐的发生率较A组降低(P<0.05)。结论与单用布托啡诺比较,开腹肝部分切除患者复合应用右美托咪定和布托啡诺实施静脉PCA镇痛效果较好,不良反应较轻。

Objective To observe the application efficiency of postoperative analgesia with combined use of dexmedetomidine and butorphanol in the patients underwent partial hepatectomy by laparotomy.Methods Sixty patients underwent partial hepatectomy by laparotomy under general anesthesia were randomly divided into two groups with 30 cases each.The intravenous patientcontrolled analgesia(PCA)with butorphanol 0.2 mg/kg+granisetron 6 mg was used in group A.The intravenous PCA with butorphanol 0.15 mg/kg+dexmedetomidine 2μg/kg+granisetron 6 mg was used in group B.The static and motic VAS pain scores and Ramsay sedation score were evaluated at 2 hours(T1),6 hours(T2),12 hours(T3),24 hours(T4)and 48 hours(T5)after operation.The total compression times of PCA during analgesia and the times of supplementary injection of analgesic drugs were recorded.The incidence rate of adverse responses was calculated.Results Compared with group A,the static VAS pain score at T2-T4,motic VAS pain score at T1-T5 and Ramsay sedation score at T1-T4 were decreased in group B(P<0.05).The number of pressing PCA pump was(2.3±0.4)times in group B,which was less than(7.8±1.1)times in group A(P<0.05).The percentage of patients needing to use supplementary injection of analgesic drugs was less in group B than that in group A(6.7%vs.26.7%)(P<0.05).The incidence rate of dizziness,sleepiness,nausea and vomiting of group B was lower than those in group A in 48 hours after operation(P<0.05).Conclusion Compared to intravenous PCA with butorphanol,intravenous PCA with combined use of butorphanol and dexmedetomidine has better postoperative analgesic effect and less adverse responses in the patients underwent partial hepatectomy by laparotomy.