不同剂量右旋美托咪定对术后谵妄和镇痛的影响  

Effects of Dexmedetomidine in Different Dosage on Postoperative Delirium and Analgesia

作　　者：沈健[1] 陈家伟[1] 缪长虹[1] 

机构地区：[1]复旦大学附属肿瘤医院麻醉科复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国临床医学》2013年第3期340-342,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨不同剂量右旋美托咪定(dexmedetomidine,DEX)对全身麻醉患者术后谵妄和镇痛的影响。方法:选取复旦大学附属肿瘤医院2012年7月至2013年1月全麻下行结直肠癌根治术的患者90例,随机分为3组:高剂量DEX组(D1组),患者在全身麻醉诱导前10 min内以1.0μg/kg剂量静脉输注DEX并以0.4μg/(kg.h)持续输注至术毕;低剂量DEX组(D2组)术前10 min内以0.5μg/kg剂量静脉输注DEX并以0.2μg/(kg.h)持续输注至术毕;对照组(C组)以0.9%氯化钠溶液代替DEX。观察记录3组患者的心率、血压、脉搏氧饱和度、术后谵妄分级量表评分、术后疼痛视觉模拟评分、术后24 h镇痛泵有效按压次数、术后镇痛药用量。结果:D1组和D2组患者术后谵妄分级量表评分均较C组患者明显降低[(9.01±3.26)、(13.96±4.03)比(16.37±4.61),均P<0.05],且D1组患者比D2组患者降低更为显著(P<0.05)。D1组患者与D2组患者相比,术后疼痛视觉模拟评分[(2.5±0.5)比(3.4±0.6),P<0.05]、术后24 h镇痛泵有效按压次数[(24±3)比(36±4),P<0.05]和术后镇痛药用量[(54.5±16.5)比(65.0±20.0),P<0.05]均明显降低;而D2组患者与C组患者相比,术后疼痛视觉模拟评分、术后24 h镇痛泵有效按压次数和术后镇痛药用量差异均无统计学意义。结论:与对照组相比,不同剂量DEX均可显著减少全身麻醉患者谵妄的发生率,高剂量DEX组与低剂量DEX组相比,术后谵妄分级量表评分降低更为显著,高剂量DEX可明显改善患者术后镇痛效果。Objective：To observe the effects of dexmedetomidine（DEX） in different dosage on the postoperative delirium and analgesia in patients receiving general anesthesia.Methods：A total of 90 patients（ASA Class I-II） scheduled for colorectal cancer surgery under general anesthesia were randomly divided into 3 groups： high DEX dosage group（Group D1）： patients were given a loading dosage of DEX（1.0 μg/kg） intravenously 10 min before the induction of general anesthesia followed by continuous infusion 0.4 μg/（kg·h） in the operation.Low DEX dosage group（Group D2）： patients were given a loading dosage of DEX（0.5 μg/kg） intravenously 10 min before the induction of general anesthesia followed by continuous infusion 0.2 μg/（kg·h） in the operation.Control group（Group C）： patients were given 0.9% saline solution instead of DEX.Heart rate,blood pressure,pulse oxygen saturation,delirium rating scale,visual analogue scale,postoperative PCIA pressing times in 24 hours and dosage of analgesic were recorded.Results： Compared with patients in Group C,patients in Group D1 and Group D2 had significantly decreased delirium rating scale（9.01±3.26）、（13.96±4.03） vs.（16.37±4.61）,both P0.05.Group D2,patients in Group D1 decreased more significantly（P0.05）.Compared with patients in Group D2,visual analogue scale（2.5±0.5） vs.（3.4±0.6）,P0.05,postoperative PCIA pressing times in 24 hours（24±3）vs.（36±4）,P0.05and dosage of analgesic（54.5±16.5） vs.（65.0±20.0）,P0.05 were significantly decreased in Group D1.However,no significant difference was found between Group D2 and Group C in visual analogue scale,postoperative PCIA pressing times in 24 hours and dosage of analgesic.Conclusions： Compared with the control group,DEX in different dosage can prevent postoperative delirium in patients receiving general anesthesia.Compared with low dosage group,the delirium rating scale decreased more significantly in the high dosage group.High dosage DEX showed an

关 键 词：右旋美托咪定 术后谵妄 术后镇痛 

分 类 号：R619[医药卫生—外科学]