右美托咪定联合舒芬太尼对达芬奇机器人辅助下行甲状腺癌根治术的镇痛效果

Analgesic effect of Dexmedetomidine combined with Sufentanil after radical thyroidectomy with the assistance of Da Vinci robot

目的:观察右美托咪定联合舒芬太尼用于达芬奇机器人辅助下甲状腺癌根治术后的镇痛效果。方法:选取2021年9月—2022年2月中国人民解放军联勤保障部队第九六〇医院收治的60例择期行达芬奇机器人辅助下甲状腺癌根治术患者为研究对象,采用随机数字表法分为D组、L组和S组各20例。D组给予右美托咪定3μg/kg联合舒芬太尼3μg/kg镇痛,L组给予机器人手臂通道罗哌卡因局部浸润麻醉镇痛,S组给予舒芬太尼3μg/kg镇痛,比较三组疼痛程度、镇静效果、血流动力学情况、不良反应发生率及患者自控镇痛泵(PCA)按压次数。结果:术后1 h,D组、L组收缩压(SBP)、舒张压(DBP)水平均低于S组,D组心率(HR)水平低于L组和S组,差异有统计学意义(P<0.05);术后6 h,D组SBP、HR水平均低于L组和S组,差异有统计学意义(P<0.01);术后18 h,D组HR水平低于S组和L组,差异有统计学意义(P<0.01);术后24 h,D组、S组DBP水平低于L组,D组HR水平低于L组和S组,差异均有统计学意义(P<0.01);术后1 h、6 h、18 h、24 h D组静息和运动视觉模拟评分法评分均低于L组和S组,差异有统计学意义(P<0.01);术后1 h、6 h、18 h、24 h D组Ramsay镇静评分均高于S组和L组,差异有统计学意义(P<0.01);D组术后不良反应总发生率低于S组和L组,L组术后不良反应总发生率低于S组,差异有统计学意义(P<0.01);D组术后PCA按压次数少于S组和L组,差异有统计学意义(P<0.01)。结论:达芬奇机器人辅助下甲状腺癌根治术患者术后应用右美托咪定联合舒芬太尼镇痛效果较好,有助于患者血流动力学稳定,减少疼痛和PCA按压次数,且不良反应较少,可以安全应用于术后镇痛中。

Objective To observe the analgesic effect of Dexmedetomidine combined with Sufentanil after radical thyroid cancer surgery assisted by Da Vinci robot.Methods A total of 60 patients who received Da Vinci robot-assisted radical thyroidectomy in the 960th Hospital of the PLA Joint Logistic Support Force from September 2021 to February 2022 were selected as the study objects,and were divided into groups D,L and S with 20 patients in each group by random number table method.Group D was given Dexmedetomidine 3μg/kg combined with Sufentanil 3μg/kg for analgesia,group L was given Ropivacaine local infiltrating anesthesia for analgesia,and group S was given Sufentanil 3μg/kg for analgesia.Pain degree,sedation effect,hemodynamics,incidence of adverse reactions and the number of patient controlled analgesia(PCA)compression were compared among the three groups.Results 1 h after operation,systolic blood pressure(SBP)and diastolic blood pressure(DBP)in groups D and L were lower than those in group S,and heart rate(HR)in group D was lower than those in group L and group S,the difference was statistically significant(P<0.05).6 h after operation,SBP and HR levels in group D were lower than those in group L and group S,with statistical significance(P<0.01).At 18 h after operation,the HR level of group D was lower than that of group S and group L,and the difference was statistically significant(P<0.01).24 h after operation,the DBP level in group D and group S was lower than that in group L,and the HR level in group D was lower than that in group L and group S,with statistical significance(P<0.01).At 1 h,6 h,18 h and 24 h after operation,the scores of resting and motor Visual Analogue Scale in group D were lower than those in group L and group S,and the difference was statistically significant(P<0.01).Ramsay Sedation score in group D was higher than that in group S and group L at 1 h,6 h,18 h and 24 h after surgery,and the difference was statistically significant(P<0.01).The total incidence of postoperative adverse reactions in group D was lower than that in group S and group L,and the total incidence of postoperative adverse reactions in group L was lower than that in group S,the difference was statistically significant(P<0.01).The number of postoperative PCA compressions in group D was less than that in group S and group L,and the difference was statistically significant(P<0.01).Conclusions Dexmedetomidine combined with Sufentanil has good analgesic effect in patients undergoing radical thyroidectomy assisted by Da Vinci robot,which helps to stabilize the hemodynamics of patients,reduce pain and PCA compression times,and has fewer adverse reactions,so it can be safely applied in postoperative analgesia.