右美托咪啶联合吗啡静脉自控镇痛对胃癌患者术后的疗效影响  

Curative Effect Influence of Dexmedetomidine Combined with Morphine in Patient-Controlling Intravenous Analgesia on Postoperative Gastric Cancer Patients

作　　者：陈荣[1,2] 邱晓东[2] 

机构地区：[1]盐城市第二人民医院,江苏盐城224000 [2]东南大学附属中大医院

出　　处：《中外医学研究》2016年第23期1-4,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:观察右美托咪啶联合吗啡静脉自控镇痛(PCIA)对胃癌患者术后的镇痛效果、不良反应及免疫功能的影响。方法:选择2015年8月-2016年3月笔者所在医院择期作胃癌根治术的患者112例,ASA分级Ⅰ~Ⅱ级,随机分为C组(对照组)和D组(右美托咪啶组),每组各56例,两组均在拔管后予以PCIA。C组给予吗啡100 mg+盐酸托烷司琼10 mg,D组采用吗啡82 mg+右美托咪啶200μg+盐酸托烷司琼10 mg。将药物加入0.9%氯化钠注射液中至总量为200 ml。镇痛泵设置为背景剂量2 ml/h,按压1次2 ml,按压后锁定时间15 min。维持VSA≤4分。记录两组术后24、48 h吗啡用量、PCA总次数和有效按压次数;记录使用镇痛泵期间不良反应(恶心呕吐、皮肤瘙痒、心动过缓、低血压、镇静过度和呼吸抑制);记录两组于麻醉前、拔管时、24 h、72 h、120 h五个时点T淋巴细胞亚群(CD3^+、CD4^+、CD8^+)及NK细胞水平。结果:与C组比较,D组术后24 h和48 h内吗啡用量、PCA总按压次数和有效按压次数少(P<0.05);与C组比较,D组恶心、呕吐和瘙痒发生率低(P<0.05);与各自基础值相比,两组CD3^+、CD4^+、CD4^+/CD8^+于拔管即刻开始下降(P<0.05),术后24 h最低(P<0.01);术后72 h,D组CD3^+、CD4^+、CD4^+/CD8^+及NK细胞计数已恢复至基础水平,而C组仍明显低于基础值及D组(P<0.05)。术后120 h两组CD3^+、CD4^+、CD4^+/CD8^+及NK细胞计数均恢复至麻醉前水平。结论:右美托咪啶联合吗啡PCIA于胃癌患者术后镇痛,可明显减少吗啡的总使用量,从而降低阿片类药品的不良反应,减轻对肿瘤患者的免疫抑制作用,提高胃癌患者的生活质量和康复预期值。Objective： To observe the influence about analgesia and adverse reactions and immunologic function of Dexmedetomidine combined with Morphine in PCIA in gastric cancer patients after abdominal operation.Method： From August 2015 to March 2016, 112 cases with selective gastrectomy of stomach neoplasms operation in our department were selected, ASA Physical status were I - II, they were randomly divided into the group C（control group） and group D （Dexmedetomidine group）.Each group had 56 cases.The PCIA pump was connected immediately after the end of surgery.Group C administrated with Morphine（100 mg）＋Tropisetron HCI（10 mg）, and group D administrated with Morphine（82 mg）＋Dexmedetomidine（200 μ g）＋Tropisetron HCI（10 mg）.All the anesthetic agents were diluted into 200 ml of 0.9% sodium chloride, PCIA was fixed as background does of 2 ml/h, does of 2 ml/once and lock time of 15 min.The VSA score was maintained below 4.The total amount of Morphine, the number of PCA and successfully control within 24 h and 48 h after operation were recorded. Postoperative complications including nausea, vomiting, bradycardia, hypotension, over sedation and respiratory depression were recorded.The expressions of T-lymphocyte subsets（CD3＋, CD4＋, CD8＋）and natural killer cells were measured by flowcytometry at five time points（before anesthesia, duringextubation, 24h, 72 h, 120 h after operation）.Result： The total amount of Morphine, the number of PCA and successfully control within 24 h and 48 h after operation were significantly smaller and the incidences of nausea and vomiting and pruritus were significantly lower in group D than those in group C（P〈0.05）.No bradycardia, hypotension, over sedation respiratory depression were observed in each group.Compared with the base lines, CD3＋, CD4＋, CD4＋/CD8＋ lymphocytes and NK cells of the two groups began to decrease during extubation（P〈0.05）, and were the lowest at 24 h after operation（P〈0.01）.In group D, the number of

关 键 词：右美托咪啶 吗啡 静脉自控镇痛 疗效 

分 类 号：R614[医药卫生—麻醉学] R735.2[医药卫生—外科学]