右美托咪定在艾滋病患者肛周手术后镇痛中的临床效果

Clinical effect of dexmedetomidine on postoperative analgesia in patients with acquired immunodeficiency syndrome underwent perianal surgery

目的观察右美托咪定(dexmedetomidine,DEX)在艾滋病(acquired immunodeficiency syndrome,AIDS)患者肛周手术后患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)中的临床效果。方法择期在腰硬联合麻醉下行肛周手术的AIDS患者90例,采取随机数字法分为观察组(O组)和对照组(C组)。O组PCIA采用舒芬太尼1.5μg/kg+DEX 2.5μg/kg+氟比洛芬酯200 mg+昂丹司琼8 mg,生理盐水稀释至200 mL,背景剂量为3 mL/h,每次追加剂量为3 mL/h,锁定时间15 min,持续输注48 h。C组PCIA不使用DEX,其余同O组。记录患者术后4、12、24、48 h静息状态下疼痛程度、镇静情况及PCIA追加药物情况,观察两组患者麻醉前、术后24、48 h血浆T淋巴细胞亚群的变化,并记录围术期不良反应发生情况及患者满意度。结果与C组相比,O组术后各时点疼痛评分降低,PCIA累计追加药物次数明显减少,患者满意度提高(P<0.05),但两组间术后镇静评分、围术期T淋巴细胞亚群及不良反应的比较差异无统计学意义(P>0.05)。结论DEX应用于AIDS患者肛周手术PCIA安全有效,有助于减轻疼痛程度、提高患者满意度,并对T淋巴细胞亚群无明显影响。

Objective To study the clinical effects of dexmedetomidine(DEX)on patient controlled intravenous analgesia(PCIA)in patients with acquired immunodeficiency syndrome(AIDS)underwent perianal surgery.Methods Ninety AIDS patients with perianal surgery under combined spinal epidural anesthesia were randomly divided into observation group(Group O)and control group(Group C).In Group O,sufentanil 1.5μg/kg+DEX 2.5μg/kg+flurbiprofen 200 mg+ondansetron 8 mg were diluted to 200 mL with normal saline in PCIA;the background infusion rate was 3 mL/h;an additional dose of 3 mL/h was permitted under a locking time of 15 min;and the total infusion time was 48 h.In Group C,DEX was not used in PCIA,the rest were the same as Group O.The degree of pain,sedation at rest 4,12,24 and 48 hours after surgery,and PCIA cumulative additional drugs were recorded.The changes of plasma T lymphocyte subsets in the two groups before anesthesia and 24 and 48 hours after operation were observed,and the occurrence of perioperative adverse reactions and patients′satisfaction were recorded.Results Compared with Group C,the pain score after surgery and cumulative additional drugs in Group O were significantly reduced;while the patients′satisfaction was significantly improved(P<0.05).However,there was no significant difference in postoperative sedation score,perioperative T lymphocyte subsets or adverse reactions between two groups(P>0.05).Conclusion DEX is safe and effective in PCIA of patients with AIDS after perianal surgery.It can reduce the degree of pain and improve patients′satisfaction,but has no significant effect on T lymphocyte subsets.