右美托咪定联合地佐辛在腹部恶性肿瘤患者术后自控镇痛中的应用  

Clinical Application of Dexmedetomidine Combined with Dezocine for Patientcontrolled Intravenous Analgesia in Patients after Abdominal Tumor Radical Surgery

作　　者：王新元[1] 甘建辉[1] 胡万宁[1] 高慧军[1] 柳浩然[1] 

机构地区：[1]河北联合大学附属唐山市人民医院,河北唐山063000

出　　处：《华西医学》2015年第4期669-672,共4页West China Medical Journal

基　　金：河北省2013年医学科学研究重点计划(20130674)~~

摘　　要：目的观察右美托咪定联合地佐辛用于患者术后静脉自控镇痛（PCIA）的有效性和安全性。方法选择2012年9月-2013年5月择期腹部恶性肿瘤手术患者60例,均自愿要求术后镇痛,年龄40-60岁,美国麻醉医师协会分级Ⅰ~Ⅱ级,随机分成两组（D组和DF组）,每组30例。D组舒芬太尼0.25μg/kg＋地佐辛0.4 mg/kg＋生理盐水至100 m L;DF组右美托咪定1.5μg/kg＋舒芬太尼0.15μg/kg＋地佐辛0.4 mg/kg＋生理盐水至100 m L。观察并记录两组患者术前和术后2、4、8、24、48 h时的平均动脉压、心率、呼吸频率、视觉模拟评分（VAS）、Ramsay镇静评分、布氏舒适评分（BCS）、PCIA有效按压次数以及不良反应发生情况。结果 DF组血流动力学较D组更为平稳（P〈0.05）;两组患者各时间点VAS、BCS比较差异无统计学意义（P〉0.05）;DF组各时间点Ramsay镇静评分优于D组,差异有统计学意义（P〈0.05）;两组患者的术后48 h内PCIA的有效按压次数差异有统计学意义（P〈0.05）;术后嗜睡发生率比较,D组明显多于DF组,差异有统计学意义（P〈0.05）。结论右美托咪定联合地佐辛用于腹部肿瘤患者术后PCIA可提供有效的镇痛效果,不良反应少,满意度高。Objective To evaluate the efficacy and safety of dexmedetomidine combined with dezocine for patient-controlled intravenous analgesia（PCIA） in patients after radical operation for abdominal tumor.Methods Between September 2012 and May 2013,60 patients（aged 40-60,American Sociaty of Anesthesiologists physical status Ⅰ-Ⅱ） undergoing abdominal tumor surgery and asking for PCIA pumps voluntarily were randomly divided into two groups（group D and group DF） with 30 in each group.Patients in group D were given sufentanil 0.25 μg/kg＋dezocine 0.4 mg/kg,which were added into 100 mL 0.9%normal saline,while in group DF,the patients received dexmedetomidine 1.5μg/kg＋ sufentanil 0.15 μg/kg＋ dezocine 0.4 mg/kg,which were added into 100 mL 0.9%normal saline.The changes of mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR）,the visual analog scale（VAS）,Ramsay sedation scale,Bruggrmann analgesia scale（BCS）,the efficacy of postoperative analgesia and adverse effects were observed and recorded at the preoperative time（T_0）,and 2（T_1,4（T_2）,8（T_3）,24（T_4） and 48 hours（T_5）postoperatively.Results Hemodynamics in group DF was more stable than that in group D（P〈0.05）.There were no statically significant differences in terms of VAS and BCS between the two groups at each time point（P〉0.05）.The Ramsay sedation scale of group DF was better than group D,and the difference was statistically significant（P〈0.05）.The efficient number of pressing within 48 hours in the two groups was not significantly different（P〉0.05）.The incidence of nausea,vomiting and drowsiness in group D was more than that of group DF（P〈0.05）.Conclusion Dexmedetomidine combined with dezocine can provide effective postoperative analgesia with less adverse effects for patients after radical surgery of abdominal tumor,which provides higher satisfaction to the abdominal surgery patients.

关 键 词：右美托咪定 地佐辛 舒芬太尼 自控镇痛 

分 类 号：R614[医药卫生—麻醉学] R735[医药卫生—外科学]