右美托咪定和咪达唑仑复合舒芬太尼在胸腔镜手术中的应用

The application value of dexmedetomidine and midazolam combined with sufentanil in thoracoscopic surgery

目的分析右美托咪定和咪达唑仑复合舒芬太尼在胸腔镜手术中的应用价值。方法选择2017年8月至2019年8月接受治疗的99例行胸腔镜手术患者,根据数字随机表法分为3组,每组33例。A组采用右美托咪定复合舒芬太尼麻醉,B组采用咪达唑仑复合舒芬太尼麻醉,C组单纯采用舒芬太尼麻醉。观察3组患者不同时段镇静、镇痛评分及术后不良反应情况。结果A组患者T3、T4疼痛VAS评分及Ramsay镇静评分明显优于C组和B组,差异有统计学意义(P<0.05)。3组患者头晕头痛、呼吸抑制、恶心呕吐等不良症状发生率差异无统计学意义(P>0.05)。A和B组患者T2、T3、T4心率及舒张压明显优于C组,A组心率及舒张压指标明显优于B组,差异有统计学意义(P<0.05)。A组患者T3、T4疼痛VAS评分及Ramsay镇静评分明显优于C组和B组,差异有统计学意义(P<0.05)。结论右美托咪定复合舒芬太尼相较于咪达唑仑复合舒芬太尼更能降低胸腔镜术中应激反应,术中血流动力学更加稳定,且安全性无明显差异,值得临床推广。

Objective To investigate the application value of dexmedetomidine and midazolam combined with sufentanil in thoracoscopic surgery.Methods A total of 99 patients who were treated by thoracoscopic surgery in our hospital from August 2017 to August 2019 were enrolled in the study,who were divided into three groups according to the digital random table method.The patients in group A(n=33)received dexmedetomidine combined with sufentanil anesthesia,and the patients in group B(n=33)received midazolam combined with sufentanil anesthesia,and the patients in group C(n=33)received sufentanil anesthesia only.The sedation effects,analgesia scores and postoperative adverse reactions at different time points were observed and compared among the three groups.Results The VAS scores and Ramsay sedation scores at T3 and T4 in group A were significantly better than those in group C and group B(P<0.05),however there were no significant differences in the incidence rates of dizziness,headache,respiratory depression,nausea and vomiting and other adverse symptoms among the three groups(P>0.05).The levels of heart rate and diastolic pressure at T2,T3 and T4 in group A and group B were significantly better than those in group C,and the levels of heart rate and diastolic pressure in group A were significantly better than those in group B(P<0.05).In addition the VAS scores and Ramsay sedation scores at T3 and T4 in group A were superior to those in group C and group B(P<0.05).Conclusion As compared with midazolam combined with sufentanil,the dexmedetomidine combined with sufentanil can better reduce intraoperative stress reaction in thoracoscopic surgery,and intraoperative hemodynamics is more stable,with good safety,therefor,which is worthy of clinical promotion.