右美托咪定用于老年卵巢癌患者术后硬膜外镇痛效果观察

Analgesia effect of dexmedetomidine on postoperative epidural analgesia in elderly patients undergoing ovarian tumor reduction

目的探讨右美托咪定复合舒芬太尼、罗哌卡因用于老年卵巢癌根治术后硬膜外镇痛的效果。方法选取2018年4月至2019年6月首都医科大学附属北京妇产医院收治的92例老年卵巢癌根治术患者,随机分为观察组和对照组,每组46例。观察组术后硬膜外镇痛泵内2μg/kg右美托咪定+0.5μg/ml舒芬太尼+0.15%罗哌卡因,对照组镇痛泵内0.5μg/ml舒芬太尼+0.15%罗哌卡因,分别在术后1、6、12、24、48 h进行疼痛视觉模拟评分(visual analogue score,VAS)、Ramsay镇静评分,术前1 d,术后24、48 h进行焦虑自评量表(self-rating anxiety scale,SAS)评分,对比两组术后镇痛、镇静、焦虑以及不良反应发生情况。结果两组术后不同时间点VAS比较,差异无统计学意义(P>0.05);观察组Ramsay镇静评分较对照组明显升高(P<0.05),SAS评分明显低于对照组(P<0.05);术后观察组镇痛泵按压次数为(2.6±0.8)次,明显少于对照组的(5.3±0.2)次(P<0.05);不良反应比较,观察组只有1例发生恶心呕吐,发生率为2.2%,对照组出现6例恶心呕吐,1例皮肤瘙痒,发生率为15.2%,差异有统计学意义(P<0.05);观察组术后各时间点MAP、HR明显低于对照组(P<0.05)。结论老年患者卵巢癌根治术后,使用右美托咪定复合舒芬太尼、罗哌卡因进行硬膜外镇痛,可提升术后镇痛效果,减少总用药量,同时防止不良反应产生。

Objective To investigate the analgesia effect of dexmedetomidine mixed with sufentanil and ropivacaine on postoperative epidural analgesia in elderly patients with ovarian cancer after surgery.Methods A total of 92 patients were randomly divided into the observation group(group D)and the control group(group C).Both groups were treated with epidural analgesia.Group D was received 2μg/kg dexmedetomidine+0.5μg/ml sufentanil+0.15%ropivacaine.Group C was received 0.5μg/ml sufentanil+0.15%ropivacaine.Pain[visual analogue score(VAS)]and sedation(Ramsay)were scored at 1,6,12,24 h and 48 h postoperatively.Anxiety[self-rating anxiety scale(SAS)]was scored at one day preoperation,24 h and48 h postoperation.Postoperative analgesia,sedation,anxiety and adverse reactions were observed between the two groups.Results There were no significant differences in VAS(P>0.05)between the two groups.The Ramsay scores of group D were higher than those of group C(P<0.05).The SAS scores of group D were lower than those of group C(P<0.05).In group D,the incidence rate of adverse reactions was significantly lower than that of the group C(P<0.05).In group D,the mean arterial pressure and heart rate were lower than those of group C(P<0.05).There was only one case of nausea and vomiting in group D,the incidence was 2.2%,there were six cases of nausea and vomiting and one case of pruritus in group C,the incidence was 15.2%.Conclusions For the elderly patients undergoing ovarian tumor reduction,dexmedetomidine mixed with sufentanil and ropivacaine on postoperative epidural analgesia can improve the effect of analgesia,reduce the dosage of postoperative drugs,and reduce the incidence rate of adverse reactions.