羟考酮联合右美托咪定在腹腔镜下结肠癌根治术患者术后静脉自控镇痛中的应用效果

Application value of oxycodone combined with dexmedetomidine in patientcontrolled intravenous analgesia after laparoscopic radical resection of colon cancer

目的探讨羟考酮联合右美托咪定在腹腔镜下结肠癌根治术患者术后静脉自控镇痛中的应用效果。方法采用随机数字表法将100例腹腔镜下结肠癌根治术患者分为4组:O组、OD组、D组和S组,每组25例。术后4组患者均进行患者静脉自控镇痛(PCIA),O组采用羟考酮,OD组采用羟考酮联合右美托咪定,D组采用右美托咪定,S组采用舒芬太尼。比较4组患者的苏醒期躁动评分、平均动脉压(MAP)、心率(HR)、静息和运动状态时的腹部视觉模拟评分法(VAS)评分、Ramsay镇静评分、不良反应发生率及疼痛控制满意度。结果4组患者组内不同时间点的MAP、HR、静息VAS评分、运动VAS评分及Ramsay镇静评分比较,差异均有统计学意义(P<0.05);4组患者间的MAP、HR、静息VAS评分、运动VAS评分及Ramsay镇静评分比较,差异均有统计学意义(P<0.05);4组患者的MAP、HR、静息VAS评分、运动VAS评分及Ramsay镇静评分在组别和时间上均不存在交互作用(P>0.05)。术后4、8、12、24 h,D组患者的MAP、HR均高于同时间点O组、OD组及S组,差异均有统计学意义(P<0.05)。术后1、4、8、12 h,S组患者的静息VAS评分和运动VAS评分均低于同时间点O组、OD组和D组,差异均有统计学意义(P<0.05);术后4、8、12、24 h,OD组患者的静息VAS评分、运动VAS评分均低于同时间点O组和D组,差异均有统计学意义(P<0.05)。术后1、4、8、12 h,O组患者的Ramsay镇静评分均低于同时间点OD组和D组,差异均有统计学意义(P<0.05)。术后OD组患者的镇痛药物用量、PCIA按压次数、有效按压次数均少于O组和D组,差异均有统计学意义(P<0.05)。OD组患者的不良反应总发生率低于O组和S组,差异均有统计学意义(P<0.05)。OD组患者的疼痛控制满意度高于其他3组,差异均有统计学意义(P<0.05)。结论羟考酮联合右美托咪定可安全用于腹腔镜下结肠癌根治术患者术后静脉自控镇痛,具有良好的镇痛和镇静效果,且不良反应发生率低,患者满意度高。

Objective To explore the clinical value of oxycodone combined with dexmedetomidine in patient-controlled intravenous analgesia(PCIA)after laparoscopic radical resection of colon cancer.Method 100 patients undergoing laparoscopic radical resection with colon cancer were randomly divided into 4 groups:group O,group OD,group D and group S,25 cases in each group.Postoperative PCIA was used in all four groups.Oxycodone was used in group O,oxycodone combined with dexmedetomidine was used in group OD,dexmedetomidine was used in group D,sufentanil was used in group S.Restlessness score in recovery period,mean arterial pressure(MAP),heart rate(HR),abdominal visual analogue scale(VAS)score,Ramsay sedation score,incidence of adverse reactions and satisfaction with pain control were compared among the four groups.Result MAP,HR,resting VAS score,exercise VAS score and Ramsay sedation score at different time points in the four groups were statistically significant(P<0.05).MAP,HR,resting VAS score,exercise VAS score and Ramsay sedation score of the four groups were statistically significant(P<0.05).There was no interaction of above indicators between group and time(P>0.05).At 4,8,12 and 24 h after operation,MAP and HR of group D were higher than those of group O,group OD and group S at the same time point(P<0.05).At 1,4,8,12 h after operation,the resting VAS score and exercise VAS score of group S were lower than those of group O,group OD and group D at the same time point(P<0.05).At 4,8,12 and 24 h after operation,the resting VAS score and exercise VAS score of group OD were lower than those of group O and group D at the same time point(P<0.05).Ramsay sedation score of group O was lower than that of group OD and group D at 1,4,8 and 12 h after operation(P<0.05).The amount of analgesics,PCIA pressing times,effective pressing times in group OD were less than those in group O and group D(P<0.05).The total incidence of adverse reactions in group OD was lower than that in group O and group S(P<0.05).The satisfaction of pain control in group OD was higher than that in other three groups(P<0.05).Conclusion Oxycodone combined with dexmedetomidine can be safely used for PCIA after laparoscopic radical resection of colon cancer,with good analgesic and sedative effects,low incidence of adverse reactions and high patient satisfaction.