右美托咪定联合布托啡诺用于心脏外科术后患者的镇痛效果研究

Analgesic effect of dexmedetomidine combined with butorphanol in patients subjected to cardiac surgery

目的探讨右美托咪定联合布托啡诺用于心脏外科术后患者的镇痛效果。方法选取威海市中心医院2019年6月至2020年8月择期行心脏外科手术的患者63例为研究对象,根据镇痛方式不同将其分为丙泊酚+舒芬太尼组(n=21)、右美托咪定+舒芬太尼组(n=23)和右美托咪定+布托啡诺组(n=19),比较三组患者术后镇痛满意度、视觉模拟评分法评分、血流动力学(心率、呼吸频率、收缩压、舒张压)变化及不良反应发生情况。结果右美托咪定+布托啡诺组患者术后镇痛满意率为94.7%(18/19),明显高于丙泊酚+舒芬太尼组的61.9%(13/21)和右美托咪定+舒芬太尼组的60.8%(14/23)(χ^(2)=6.16、6.57,均P<0.05);右美托咪定+布托啡诺组患者拔管4 h、12 h、24 h、48 h视觉模拟评分法评分均明显低于丙泊酚+舒芬太尼组和右美托咪定+舒芬太尼组(均P<0.05);右美托咪定+布托啡诺组拔管时、拔管后5 min心率、呼吸频率、收缩压、舒张压均低于丙泊酚+舒芬太尼组和右美托咪定+舒芬太尼组(均P<0.05);右美托咪定+布托啡诺组患者术后不良反应率[10.5%(2/19)]明显低于丙泊酚+舒芬太尼组[23.8%(5/21)]和右美托咪定+舒芬太尼组[30.4%(7/23)],差异有统计学意义(χ^(2)=21.94,P<0.001)。结论右美托咪定联合布托啡诺用于心脏外科手术,不仅可稳定患者术后血压及心率,还能减轻患者疼痛,安全性高。

Objective To investigate the effect of dexmedetomidine combined with butorphanol on perioperative analgesia in patients subjected to cardiac surgery.Methods Sixty-three patients who underwent elective cardiac surgery in Weihai Central Hospital from June 2019 to August 2020 were included in this study.They were divided into propofol+sufentanil group(n=21),dexmedetomidine+sufentanil group(n=23)and dexmedetomidine+butorphanol group(n=19)according to different analgesic methods.Postoperative analgesic satisfaction,Visual Analogue Scale score,hemodynamic changes(heart rate,respiratory rate,systolic blood pressure,diastolic blood pressure)and adverse reactions were compared among the three groups.Results The satisfaction rate of postoperative analgesia in the dexmedetomidine+butorphanol group was 94.7%(18/19),which was significantly higher than 61.9%(13/21)in the propofol+sufentanil group and 60.8%(14/23)in the dexmedetomidine+sufentanil group(χ^(2)=6.16,6.57,both P<0.05).At 4,12,24 and 48 hours after tracheal extubation,Visual Analogue Scale score in the dexmedetomidine+butorphanol group were significantly lower than that in the propofol+sufentanil group and dexmedetomidine+sufentanil group(both P<0.05).At the time of tracheal extubation and at 5 minutes after tracheal extubation,heart rate,respiratory rate,systolic blood pressure and diastolic blood pressure in the dexmedetomidine+butorphanol group were significantly lower than those in the propofol+sufentanil group and dexmedetomidine+sufentanil group(both P<0.05).The incidence of adverse reactions in the dexmedetomidine+butorphanol group was 10.5%(2/19),which was significantly lower than 23.8%(5/21)in the propofol+sufentanil group and 30.43%(7/23)in the dexmedetomidine+sufentanil group[30.4%(7/23),χ^(2)=21.94,P<0.001].Conclusion Dexmedetomidine combined with butorphanol in cardiac surgery can not only stabilize postoperative blood pressure and heart rate,but also lower the degree of pain and is highly safe.