右美托咪定不同方案对胸外科术后患者镇痛效果临床观察

Ananlgesic effects of different regimens of dexmedetomidine on patients after thoracic surgery

目的:探讨右美托咪定不同方案对胸外科术后患者的效果。方法:选取胸外科手术治疗且需要术后镇痛患者60例,采用随机数字表法分为D_(0)组、D_(全)组和D_(时)组,每组20例。D_(0)组给予全程传统静脉自控镇痛(PCIA)方案。D_(全)组在D_(0)组基础上加用200μg右美托咪定。D_(时)组给予分时段术后镇痛方案。比较三组患者术后不同时间点疼痛视觉模拟量表(VAS)评分、美国国立卫生研究院卒中量表-1a意识(NIHSS-1a)评分、改良Barthel指数量表(MBI)评分、半定量咳嗽强度(SCSS)评分、生理指标[平均动脉压(MAP)、心率(HR)、呼吸频率(RR)和血氧饱和度(SpO_(2))]以及术后7 d内并发症发生情况。结果:术后第6小时,D_(0)组VAS评分高于D_(全)组和D_(时)组(均P<0.05)。术后第12、24、36、48、72小时,以及第4、7天,D_(时)组和D_(全)组VAS评分低于D_(0)组,且D_(全)组低于D_(时)组(均P<0.05)。术后第3、4、7天,D_(时)组MBI评分高于D_(0)组和D_(全)组,且D_(0)组高于D_(全)组(均P<0.05)。术后第24小时,D_(0)组、D_(时)组NIHSS-1a评分低于D_(全)组(均P<0.05)。术后第36、48、72小时,D_(时)组NIHSS-1a评分低于D_(0)组和D_(全)组,且D_(0)组低于D_(全)组(均P<0.05)。术后第3、4、7天,D_(时)组MBI评分高于D_(0)组和D_(全)组,且D_(0)组高于D_(全)组(均P<0.05)。术后第48小时,D_(0)组、D_(时)组SCSS评分高于D_(全)组(均P<0.05);三组患者MAP、HR、RR和SpO_(2)水平比较差异无统计学意义(均P>0.05)。术后7 d内,三组患者并发症发生率比较差异无统计学意义(均P>0.05)。结论:右美托咪定术后分时段镇痛方案可有效降低胸外科患者术后疼痛程度,不易出现麻醉药物镇静过度现象,且对患者术后咳嗽及日常生活能力有积极影响,对患者术后生理指标及并发症影响较小,具有较好的安全性。

Objective:To investigate the effects of different regimens of dexmedetomidine on patients after thoracic surgery.Methods:Sixty patients undergoing thoracic surgery and requiring postoperative analgesia were randomly divided into D_(0)group,D_(whole)group and D_(time)group,with 20 cases in each group.Patients in D_(0)group were given whole course of traditional PCIA.D_(whole)Group was treated with 200μg dexmedetomidine in addition to D_(0)group.Patients in D_(time)group were given postoperative time-phased analgesia.The VAS score,NIHSS-1a score,MBI score,SCSS score,physiological indexes(MAP,HR,RR and SpO_(2))at different time points after operation,and complications within 7 days after operation were compared among the three groups.Results:At 6 hours after operation,VAS score in D_(0)group was higher than that in D_(whole)group and D_(time)group(both P<0.05).At 12,24,36,48,72 hours,and 4,7 days after operation,the VAS scores of D_(whole)group and D_(time)group were lower than those of D_(0)group,and the VAS scores of D_(whole)group were lower than those of D_(time)group(all P<0.05).On the 3rd,4th and 7th day after operation,the MBI scores of D_(time)group was higher than that of D_(0)group and D_(whole)group,and that of D_(0)group was higher than D_(whole)group(all P<0.05).At 24 hours after surgery,NIHSS-1a scores in D_(0)group and D_(time)group were lower than that in D_(whole)group(all P<0.05).At 36,48 and 72 hours after operation,the NIHSS-1a score in D_(time)group was lower than that in D_(0)group and D_(whole)group,and that in D_(0)group was lower than that in D_(whole)group(all P<0.05).On the 3rd,4th and 7th day after operation,the MBI score of D_(time)group was higher than that of D_(0)group and D_(whole)group,and that of D_(0)group was higher than D_(whole)group(all P<0.05).At 48 hours after operation,the SCSS scores of D_(0)group and D_(time)group were higher than that of the whole D_(whole)group(all P<0.05).There were no significant differences in MAP,HR,RR and SpO_(2)levels among the three groups(all P>0.05).There was no significant difference in the incidence of complications among the three groups within 7 days after operation(all P>0.05).Conclusion:Time-phased analgesia with dexmedetomidine can effectively reduce the degree of postoperative pain in patients undergoing thoracic surgery,and will not easily show excessive sedation.It has a positive effect on postoperative cough and daily living ability of patients,and has little effect on postoperative physiological indexes and complications,with good safety.