右美托咪定和异丙酚用于冠心病患者非心脏手术的镇痛效果比较  

Analgesic effect of dexmedetomidine versus propofol on patients with coronary heart disease undergoing noncardiac surgery

作　　者：于振宇[1] 刘国锋[2] 于建宏[1] 

机构地区：[1]山东省烟台毓璜顶医院麻醉科,264000 [2]莱州市人民医院麻醉科

出　　处：《中华老年医学杂志》2013年第11期1161-1163,共3页Chinese Journal of Geriatrics

摘　　要：目的比较右美托咪定与异丙酚在冠心病患者非心脏手术中的镇痛效果。方法选择2009年9月至2011年9月于我院收治的硬膜外麻醉下择期行上腹部手术的冠心病患者86例，年龄55～76岁，体质量42～60kg，随机分为右美托咪定组和异丙酚组，每组43例，采用视觉模拟评分法（VAs）检测患者术前、术后4、24、48h末血清皮质醇、胰岛素和血糖的含量变化来评价两组患者的镇痛效果，并术后进行满意度调查。结果术后不同时点VAS镇痛评分和Ramsay镇静评分结果显示，右美托咪定组患者的镇痛镇静效果优于异丙酚组，差异有统计学意义（t=5．368、2．262、7．147、5．881、7．861、4．810，P〈0．05）。右美托咪定组患者清皮质醇、胰岛素和血糖浓度在术前及术后各个时间点均低于异丙酚组患者，差异有统计学意义（t=3．076、2．042、4．090，P〈O．05），且93．0％（40／43）的患者对Dex组满意。结论右美托咪定用于冠心病患者非心脏手术的镇痛效果优于异丙酚，且安全可行。Objective To compare the analgesic effect of dexmedetomidine and propofol on patients with coronary heart disease undergoing noncardiac surgery. Methods 86 patients in our hospital from Sep 2009 to Sep 2011 aged 55-76 years weighing 42-60 kg, who were scheduled for epidural anesthesia in routine,were randomly assigned to 2 groups： dexmedtomidine （Dex） group and propofol group （n = 43, each）. Visual analogue scale/score （VAS） analgesia score and ramsay sedation score were used to observe the analgesic effect after surgery. Serum concentration of cortisol, insulin and glucose were observed and compared between Dex and propofol group before and 4, 24, 48 h after surgery. Patient satisfaction was surveyed. Results The analgesic effect evaluated by VAS and Ramsay scores was better in Dex group than in propofol group at different time after surgery （t= 5. 368, 2. 262, 7. 147, 5. 881, 7. 861, 4. 810,all P〈0.05）. Serum concentrations of cortisol, insulin and glucose were lower in Dex group than in propofol group before and 4, 24, 48 h after surgery （t= 3.076, 2.042, 4.090,all P%0.05）. The satisfaction rate was 93. 0% （40/43） in Dex group. Conclusions Dexmedetomidine has a better analgesic effect than propofol, and it is safe and feasible for patients with coronary heart disease undergoing noncardiac surgery.

关 键 词：右美托咪定 二异丙酚 冠心病 

分 类 号：R614[医药卫生—麻醉学]