不同剂量右美托咪定辅助舒芬太尼用于癌痛患者PCIA镇痛的比较

Comparison of different doses of dexmedetomidine combined with sufentanil for PCIA analgesia in patients with cancer pain

目的比较右美托咪定两种剂量与舒芬太尼联合用于晚期癌痛患者镇痛效果。方法选择2018年6月至2020年7月于盘锦市人民医院肿瘤病房行疼痛治疗的癌痛患者60例,将患者随机分为对照组(20例)和实验组(40例)。其中,实验组由E1组(20例)和E2组(20例)组成,E1组为舒芬太尼150μg+右美托咪定100μg;E2组为舒芬太尼150μg+右美托咪定200μg,对照组为SF组(20例)为舒芬太尼300μg。各组液体总量均为100 ml,负荷量均为10μg舒芬太尼静脉滴注,均预防性静脉滴注格拉斯琼3 mg。镇痛泵设置持续2 ml/h,追加剂量(PCA)1.5 ml,锁定时间20 min,出现不良反应(恶心、呕吐)给予格拉斯琼3 mg和地塞米松5 mg在滴壶中静脉滴注。记录三组患者分别在4、8、16、24 h时段的MAP、HR、Ramsay镇静评分、NRS评分、不良反应发生率的数据,并做统计学分析。结果各组的NRS评分差异无统计学意义(P>0.05);而在循环抑制、镇静深度、不良反应等方面三组比较,差异有统计学意义(P<0.05),E2组MAP、HR下降明显;Ramsay镇静评分比较SF组与E1组、E2组两组差异均有统计学意义(P<0.001),且E2组在24 h时段出现深度镇静状态;不良反应发生率SF组高于其他两组(P<0.05)。结论应用低剂量的右美托咪定既避免了大剂量右美托咪定导致过度镇静又减少阿片类药物的剂量,间接降低药物副作用,同时增强患者的舒适度。

Objective To compare the analgesic effects of two doses of dexmedetomidine combined with sufentanil in patients with advanced cancer pain.Methods A total of 60 patients with cancer pain who underwent pain treatment in our oncology ward from June 2018 to July 2020 were selected,and they were randomly divided into the control group(n=20)and the experimental group(n=40).The experimental group was composed of group E1(20 cases,treated with 150μg of sufentanil+100μg of dexmedetomidine)and group E2(20 cases,treated with 150μg of sufentanil+200μg of dexmedetomidine).The control group(group SF)contained 20 cases,which treated with 300μg of sufentanil.Each group was given a total volume of 100 ml fluid and a loading dose of 10 ug sufentanil injection.All groups were given preventive intravenous infusion of granisetron 3 mg.The analgesic pump was set at 2 ml/h continuously,and the additional dose Patient-controlled-analgesia(PCA)was 1.5 ml with a lockout time of 20 min.3 mg of granisetron and 5 mg of dexamethasone were given in a drip bottle in case of adverse reactions(ARs)such as nausea and vomiting.The data of mean arterial pressure(MAP),heart rate(HR),Ramsay sedation score,score of Numerical Rating Scale(NRS)and the incidence of ARs in the three groups were recorded at 4 h,8 h,16 h,and 24 h respectively,and were statistically analyzed.Results The analgesic effect of each group was perfect,and there was no statistically significant difference in NRS scores(P>0.05).However,there were significant differences in circulatory depression,depth of sedation and ARs in the three groups(P<0.05),and MAP and HR decreased significantly in group E2.There were statistically significant differences in Ramsay sedation scores between group SF and group E1,E2(P<0.05).In addition,group E2 showed deep sedation at 24 h.The incidence of ARs in group SF was higher than that in the other two groups(P<0.05).Conclusion The application of low dose of dexmedetomidine not only avoids excessive sedation caused by high dose of dexmedetomidine but also reduces the dose of opioids,which indirectly reduces the side effects of drugs and enhances the comfort of patients.