右美托咪定复合曲马多用于单纯性肾切除患者术后镇痛的疗效观察  

Effect of dexmedetomidine combined with tramadol on analgesia after simple nephrectomy

作　　者：金春姬[1] 许霁虹[1] 周锦[1] 朴永奎 崔小鹏[1] 

机构地区：[1]沈阳军区总医院麻醉科,沈阳110016

出　　处：《实用药物与临床》2016年第12期1506-1509,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨右美托咪定复合曲马多对全麻术后躁动、镇痛效果和不良反应的影响。方法纳入132例择期单纯性肾切除术患者,均接受全身麻醉,年龄18-65岁,ASAⅠ-Ⅱ级。随机分为2组：单纯曲马多组（对照组,66例）、曲马多联合右美托咪定组（试验组,66例）。分别记录拔除气管导管前（T0）、拔除气管导管后即刻（T1）、术后1 h（T2）和术后2 h（T3）的血压、心率、血氧饱和度等生命体征变化。在拔管前评估患者躁动评分。在术后2、12、24、48 h各时点评估患者的VAS疼痛评分和Ramsay镇静评分。记录术后24 h、48 h曲马多消耗量,评估患者术后24 h、48 h的镇痛总体满意度和总体睡眠质量评分,记录不良反应发生率。结果试验组在T1时的心率及T0时的躁动评分均低于对照组（P〈0.05）。术后24 h,试验组的VAS评分低于对照组（P〈0.05）;拔管后及术后2 h、24 h,试验组Ramsay评分高于对照组（P〈0.05）。术后24 h、48 h,试验组的曲马多消耗量少于对照组（P〈0.05）;术后24 h,试验组的镇痛总体满意度和总体睡眠评分明显优于对照组（P〈0.05）,头晕、恶心、呕吐的发生率低于对照组（P〈0.05）。结论曲马多和右美托咪定联合应用的循环功能较单独应用曲马多更稳定,镇痛和镇静效果更完善,并且明显降低了恢复期的不良反应发生率。Objective To discuss the effect of dexmedetomidine combined with tramadol on agitation,analgesia and adverse reactions after general anesthesia.Methods Totally 132 patients undergoing elective simple nephrectomy and general anesthesia aged 18-65 years with ASA Ⅰ-Ⅱ were chosen.All the cases were randomly divided into2 groups：tramadol group（control group,n =66） and dexmedetomidine ＋ tramadol group（experiment group,n =66）.The SpO2,HR and BP of patients in PACU were recorded at different time points：before extubation（T0） immediately after extubation（T1）,1 h after operation（T2） and 2 h after operation（T3）.The agitation scores were assessed before extubation.The VAS and Ramsay scores were assessed at 2 h,12 h,24 h and 48 h after operation.The tramadol consumption,satisfactory degree of analgesia and sleep quality scores at 24 h and 48 h after PCIA were recorded,and the adverse reaction rate was observed within 48 h.Results In PACU,the HR at T1 and agitation score at T0 in experiment group were lower than those of control group（P〈0.05）.The VAS score in experiment group was lower than that of control group at 24 h after operation（P〈0.05）.The Ramsay score in experiment group was higher than that of control group after extubation and at 2 h and 24 h after operation（P〈0.05）.The tramadol requirement in experiment group was less than that of control group at 24 h and 48 h after operation（P〈0.05）.The satisfactory degree of analgesia and sleep quality score in experiment group were better than those of control group with lower incidence of dizzy,nausea and vomiting.Conclusion Dexmedetomidine combined with tramadol PCIA has more stable and better analgesic and sedative effect than tramadol alone on patients after simple nephrectomy,and can reduce the incidence of adverse reactions obviously.

关 键 词：右美托咪定 曲马多 患者自控静脉镇痛 肾切除术 

分 类 号：R614[医药卫生—麻醉学]