右美托咪定对胃大部切除术后吗啡镇痛效果的影响  

Effect of dexmedetomidine used during subtotal gastrectomy on postoperative analgesia with morphine

作　　者：单嘉琪[1] 江伟[1] 缪长虹[2] 张燕影[3] 

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海200233 [2]复旦大学附属肿瘤医院麻醉科 [3]复旦大学附属中山医院麻醉科

出　　处：《上海医学》2015年第10期756-758,共3页Shanghai Medical Journal

摘　　要：目的观察术中应用右美托咪定对胃大部切除术后应用吗啡进行经静脉患者自控镇痛(PCIA)效果的影响。方法选取拟行胃大部切除术的患者30例,美国麻醉医师协会分级Ⅰ或Ⅱ级,随机分入右美托咪定组(DEX组)和0.9%氯化钠溶液组(对照组),每组15例。麻醉诱导后,DEX组于手术划皮前经静脉泵注射右美托咪定0.5μg/kg,10min内输注完毕,术中以DEX 0.2μg·kg^(-1)·h^(-1)维持,至手术结束前30min停止用药;对照组注射等容量的0.9%氯化钠溶液,方法同DEX组。所有患者术后均行吗啡PCIA。分别于术后1、4、8、12、24h记录患者的疼痛视觉模拟评分(VAS评分),并记录术后第1次追加镇痛药的时间、术后24h吗啡总消耗量和术后不良反应的发生情况。结果 DEX组术后1、4、8、12h的疼痛VAS评分均显著低于对照组同时间点(P值均<0.05),两组间术后24h的疼痛VAS评分的差异无统计学意义(P>0.05)。DEX组术后第1次追加镇痛药物的时间显著迟于对照组(P<0.05),术后24h吗啡总消耗量显著少于对照组(P<0.05)。两组间术后恶心呕吐发生率的差异无统计学意义(P>0.05)。结论术中应用右美托咪定可显著提高术后应用吗啡进行PCIA的镇痛效果,并可减少阿片类药物的用量。Objective To observe the effect of dexmedetomidine on patient-controlled intravenous analgesia （PCIA） with morphine after subtotal gastrectomy. Methods Thirty patients scheduled for subtotal gastrectomy, American Society of Anesthesiologists （ASA） physical status I or H were randomly divided into two groups （n = 15）： dexmedetomidine group and control group. After induction of anesthesia, dexmedetomidine 0.5 μg/kg was injected by venous pump in 10 min before incision and then were maintained at 0.2 μg·kg^-1·h^-1until 30 min before the end of the surgery in the dexmedetomidine group. The same volume of normal saline was given to the control group. After the operation, PCIA with morphine started in all the patients. The analgesic efficacy was observed, including visual analogue scale （VAS） at the time points of 1, 4, 8, 12, and 24 h after surgery, 1= morphine bolus time, morphine consumption, and adverse reaction. Results The VAS score in the dexmedetomidine group was significantly lower than that in the control group at the time points of 1, 4, 8, and 12 h after surgery （all P〈0.05）, while there was no significant difference in the VAS at 24 h after surgery between groups （P〉0.05）. The 1st morphine bolus time in the dexmedetomidine group was significantly later than that in the control group （P〈0.05）. The consumption of morphine in the dexmedetomidine group was significantly less than that in the control group （P〈0.05）. There were no significant differences in the incidence of postoperative nausea or vomiting between groups （P〉0.05）. Conclusion Intraoperative dexmedetomidine can enhance the postoperative analgesic efficacy of PCIA with morphine and decrease the consumption of opioids.

关 键 词：右美托咪定 吗啡 镇痛效果 

分 类 号：R614[医药卫生—麻醉学]