小剂量右美托咪定复合地佐辛在开胸手术术后镇痛中的应用  

The significance of application of small dosage of dexmedetomidine combined with dezocine for postoperative analgesia in thoracic surgery

作　　者：王劭恒[1] 关雷[1] 肖莉[1] 陈立芳[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院麻醉科,北京100038

出　　处：《临床和实验医学杂志》2016年第18期1845-1849,共5页Journal of Clinical and Experimental Medicine

摘　　要：目的 观察小剂量右美托咪定（DEX）复合地佐辛在胸科手术术后镇痛的效果。方法 选择ASA Ⅰ-Ⅱ级择期行开胸手术患者45例,随机均分为三组,P组术后镇痛给予地佐辛1.0 mg/kg,同时予盐水安慰剂持续泵入;D1组在P组的基础上,给予右美托咪定0.1 g/（kg·h）持续静脉注入;D2组术后镇痛药与D1组相同,只是右美托咪定0.2 g/（kg·h）。地佐辛输注的背景速度为2 ml/h,单次按压追加剂量为1 ml/h,锁定时间15 min。记录患者术后入胸科ICU2 h（T1）、4 h（T2）、6 h（T3）、12 h（T4）、24 h（T5）、48 h（T6）血压、心率、呼吸频率、血氧饱和度、VAS评分、Ramsay评分,以及相关不良反应;同时记录各时间点地佐辛消耗量。结果 与P组比较,D1、D2组各时间点VAS评分均明显降低（P〈0.05）,Ramsay评分明显升高（P〈0.05）。D1与D2组比较,VAS评分无统计学差异（P〉0.05）,而D2组T3、T4时间点Ramsay评分明显高于D1组（P〈0.05）。与P组比较,D1、D2组T1、T2、T3、T4时间点血压、心率更稳定,各时间点地佐辛消耗量明显减少（P〈0.05）,D2组地佐辛消耗量在T4、T5、T6时间点明显小于D1组（P〈0.05）。D1、D2组不良反应发生率低于P组（P〈0.05）,D1与D2组不良反应发生率无显著差异。（P〉0.05）。结论 小剂量（0.1-0.2g/（kg·h）右美托咪定可明显减少地佐辛的镇痛用量,可给开胸手术患者提供较好的术后镇痛及镇静,血流动力学稳定,并减少术后不良反应。Objective To observe the clinical effect of application of small dosage dexmedetomidine combined with dezocine for postopera tive analgesia in thoracic surgery. Methords 4 5 selective patients undergoing thoracic surgery, ASAⅠ-Ⅱ,were recruited and divided into three groups by the dosage of dexmedetomidine used,including the placebo group （ P） with continuous pumping of normal saline; the dosage of dexmedetomidine in group 1 （D1） was 0. 1 ug/ （ kg. h） for sustained infusion and the dosage in group 2 （ D2） was same as that of group 1. Dexmedetomidine was continuously and intravenously infused to patients in D1 and D2 groups, at dosage of 0. 1 g/（kg · h） and 0.2 mg/ （kg · h） respectively. The dosage of dezocine in all patients was 1.0 mg/kg （diluted to 100ml and filled in the anesthesia pump） for I. V infusion. Patient -controlled analgesia was programmed to deliver lml/h per demand, 15 minutes lockout interval and a background infusion of 2 ml/h. The mean artery pressure, heart rate, respiratory rate, blood oxygen saturation, VAS scores, Ramsay scores, adverse reactions and the cumulative consump-tion of dezocine were recorded at six different time points in 48 hours after patients admitted to SICU, including 2 hours （Tl） , 4 hours （T2） , 6 hours （T3） , 12 hours （T4） , 24 hours （T5） and 48 hours （T6） time points. Results In comparison with the placebo group, V A S scores were higher, and Ramsay scores were lower in D1 and D2 groups （ P 〈 0 . 0 5 ） at six different time points. T h e difference in VAS scores between D 1 and D2 groups was not statistically significant, but Ramsay scores in D2 group were higher than those of D1 group （ P 〈 0 . 0 5 ） at T 3 and T4. The hemodynamic stability in D1 and D2 groups was better than that of placebo group at T1 - 4, estimated by MAP and HR. The consumption of dezocine was increased in placebo group than other two groups （ P 〈 0 . 0 5 ） at six different time points, and it was als

关 键 词：开胸手术 术后镇痛 右美托咪定 地佐辛 

分 类 号：R614[医药卫生—麻醉学]