氢吗啡酮联合不同剂量右美托咪定用于老年前列腺癌患者术后镇痛的临床研究

Effect of hydromorphone combined with different doses of dexmedetomidine on postoperative analgesia in elderly patients undergoing laparoscopic radical prostatectomy

目的观察氢吗啡酮联合不同剂量右美托咪定用于腹腔镜下老年前列腺癌患者术后镇痛的效果。方法将纳入研究的拟行腹腔镜下前列腺癌根治术的老年患者75例采用随机数字方法随机分为3组,H组、HD_1组及HD_2组,每组各25例。3组患者分别在术毕前30 min,经静脉缓慢注射氢吗啡酮20μg/kg后接静脉镇痛泵,H组配方为氢吗啡酮0.1 mg/kg用生理盐水稀释至100 ml;HD_1组配方为氢吗啡酮0.1 mg/kg联合右美托咪定2μg/kg用生理盐水稀释至100 ml;HD_2组配方为氢吗啡酮0.1 mg/kg联合右美托咪定4μg/kg用生理盐水稀释至100ml。监测并记录3组患者术后苏醒时间,拔管时间、复苏室停留时间、术后1 h(T_1)、6 h(T_2)、12 h(T_3)、24 h(T_4)、36 h(T_5)、48 h(T_6)VAS评分、Ramsay评分、肛门排气时间及不良反应诸如恶心呕吐、皮肤瘙痒、呼吸抑制、心动过缓、低血压及口干的发生情况。结果 3组患者在术后苏醒时间、拔管时间、复苏室停留时间及术后各时间点Ramsay评分方面差异无统计学意义(P>0.05)。HD_1、HD_2组VAS评分除T1时点外,其他各时间点VAS评分明显低于H组(P<0.05),肛门排气时间明显快于H组(P<0.05),术后不良反应方面,HD_2组患者在术后口干及低血压发生率方面明显高于H组和DH_1组患者,其他差异无统计学意义。结论 0.1 mg/kg氢吗啡酮复合2μg/kg右美托咪定用于老年患者前列腺癌术后镇痛效果好,不良反应少,值得临床推广应用。

Objective To investigate the effect of hydromorphone combined with different doses of dexmedetomidine on postoperative analgesia in elderly patients undergoing laparoscopic radical prostatectomy. Methods Seventy-five elderly patients undergoing laparoscopic radical prostatectomy were randomly divided into three groups( 25 cases in each group) :Group H,Group HD_1 and Group HD_2. All patients were given intravenous analgesia pump with 20 μg/kg hydromorphone by intravenous injection 30 minutes before the surgery was finished. 0. 1 mg/kg hydromorphone and normal saline to 100 ml for Group H,hydromorphone 0. 1 mg/kg combined with dexmedetomidine 2 μg/kg and normal saline to 100 ml for Group HD_1,and hydromorphone 0. 1 mg/kg combined with dexmedetomidine 4 μg/kg and normal saline to 100 ml for Group HD_2. The recovery time,time to extubation,residence time of resuscitation,VAS scores and Ramsay scores at 1 h( T_1),6 h( T_2),12 h( T_3),24 h( T_4),36 h( T_5),48 h( T_6) after the operation and adverse events were monitored and recorded. The the time to first flatus and occurrence of side reaction such as nausea and vomiting,skin pruritus,respiration inhibition,bradycardia,hypotension and dry mouth were also investigated. Results There were no statistical significance among the three groups in the difference of recovery time,time to extubation,the residence time of resuscitation and the Ramsay scores( P > 0. 05). The VAS scores in both group HD_1 and group HD_2 were significantly lower than that in group H. The occurrence of dry mouth and hypotension in group HD_2 was significantly higher than that of both group H and group DH_1,the others about adverse reaction were on significance difference among the three Groups. Conclusion It is effective and have less adverse reactions to use hydromorphone combined with 2 μg/kg dexmedetomidine in postoperative analgesia for the elderly patients undergoing laparoscopic radical prostatectomy. We consider that it is worth recommending.