预注右美托咪定联合地佐辛对胸腔镜手术患者应激反应及术后疼痛的影响

Effect of Premedication of Dexmedetomidine Combined with Dezocine on Stress Response and Postoperative Pain in Patients Undergoing Thoracoscopic Surgery

目的:探讨预注右美托咪定(Dex)联合地佐辛对胸腔镜手术患者应激反应及术后疼痛的影响。方法:选择2019年1月-2020年4月60例胸腔镜手术患者,采用随机数字表法将其分为地佐辛组(D组)和Dex联合地佐辛组(DD组),每组30例。D组于诱导前15 min静脉注射地佐辛0.15 mg/kg,DD组于诱导前15 min泵注Dex 0.5μg/kg+静脉注射地佐辛0.15 mg/kg。比较两组诱导前(T1)、插管即刻(T2)、插管后5 min(T3)、拔管前(T4)、拔管即刻(T5)、拔管后5 min(T6)MAP、HR变化。观察两组苏醒时间、拔管时间。记录两组术后4、8、12、24、48 h VAS评分和术后舒芬太尼首次追加时间、术后24 h舒芬太尼用量。结果:DD组T2、T5时MAP、HR均低于D组,差异有统计学意义(P<0.05)。两组苏醒时间、拔管时间比较差异均无统计学意义(P>0.05)。DD组术后8、12、24 h VAS评分均低于D组,差异有统计学意义(P<0.05)。DD组术后舒芬太尼首次追加时间晚于D组,术后24 h舒芬太尼用量少于D组,差异均有统计学意义(P<0.05)。结论:预注Dex联合地佐辛可有效降低胸腔镜手术患者应激反应及术后疼痛,不影响苏醒时间、拔管时间。

Objective:To investigate the effect of premedication of Dexmedetomidine(Dex)combined with Dezocine on stress response and postoperative pain in patients undergoing thoracoscopic surgery.Method:A total of 60 patients undergoing thoracoscopic surgery from January 2019 to April 2020 were selected and divided into the Dezocine group(group D)and the Dex combined Dezocine group(group DD)by random number table method,with 30 patients in each group.Group D was injected with 0.15 mg/kg of Dezocine intravenously 15 min before induction,and group DD was injected with Dex 0.5 g/kg and 0.15 mg/kg of Dezocine intravenously 15 min before induction.The changes of MAP and HR before induction(T1),at intubation(T2),5 min after intubation(T3),before extubation(T4),at extubation(T5),5 min after extubation(T6)were compared between two groups.The recovery time and extubation time of the two groups were observed.VAS scores at 4,8,12,24,48 h after surgery and the first additional time of Sufentanil after surgery and the dosage of Sufentanil in 24 h after surgery were recorded in two groups.Result:MAP and HR at T2,T5 in group DD were lower than those in group D,the differences were statistically significant(P<0.05).There were no significant differences in recovery time and extubation time between the two groups(P>0.05).VAS scores at 8,12,24 h after surgery in group DD were lower than those in group D,the differences were statistically significant(P<0.05).The first additional time of Sufentanil in group DD was later than that in group D,and the dosage of Sufentanil in 24 h after surgery was less than that in group D,the differences were statistically significant(P<0.05).Conclusion:Premedication of Dex combined with Dezocine can effectively reduce the stress response and postoperative pain in patients undergoing thoracoscopic surgery,without affecting the recovery time and extubation time.