右美托咪啶复合舒芬太尼对游离皮瓣移植术后镇痛效果及血管危象的影响  

Effect of dexmedetomidine combined with sufentanil on postoperative analgesia and the vascular crisis in patients undergoing free flap transplantation

作　　者：王冬冬[1] 马婷婷[1] 黄凯[1] Wang Dongdong Ma Tingting Huang Kai(Tongde Hospital of Zhejiang Province, Hangzhou 310012, China)

机构地区：[1]浙江省立同德医院麻醉科,杭州310012

出　　处：《中国医师进修杂志》2017年第1期59-62,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的：探讨右美托咪啶复合舒芬太尼对游离皮瓣移植术后镇痛效果及血管危象的影响。方法选择ASA分级Ⅰ～Ⅱ级择期行游离股前外侧皮瓣移植修复软组织缺损患者40例，按随机数字表法分为Ⅰ组和Ⅱ组，每组20例。Ⅰ组患者自控静脉镇痛（PCIA）药物：舒芬太尼1.0μg/（kg · d）＋托烷司琼5 mg/100 ml，Ⅱ组PCIA药物：舒芬太尼1.0μg/（kg · d）＋右美托咪啶1.0μg/（kg·d）＋托烷司琼5 mg/100 ml。两组PCIA泵持续量2 ml/h，单次负荷剂量2 ml，锁定时间15 min。记录两组疼痛视觉模拟评分（VAS）、Ramsay镇静评分、术后48 h内PCIA泵按压次数、术后满意度评分及不良反应和血管危象发生情况。结果Ⅱ组术后6、12、24及48 h VAS均明显低于Ⅰ组[（2.18±0.41）分比（3.00±0.63）分、（2.64±0.51）分比（3.82±0.60）分、（2.55±0.52）分比（3.36±0.51）分和（2.27±0.47）分比（3.09±0.70）分]，Ramsay 镇静评分均明显高于Ⅰ组[（2.42±0.51）分比（2.00±0.58）分、（2.74±0.45）分比（2.11±0.57）分、（2.58±0.51）分比（2.05±0.52）分和（2.53±0.51）分比（2.00±0.47）分]，差异有统计学意义（P〈0.05）。Ⅱ组术后48 h内PCIA泵按压次数明显少于Ⅰ组[（3.75±1.45）次比（8.25±2.61）次]，术后满意度评分明显高于Ⅰ组[（2.47±0.51）分比（1.60±0.50）分]，差异有统计学意义（P〈0.05）。两组总不良反应发生率和血管危象发生率比较差异无统计学意义（P＞0.05）。结论右美托咪啶辅助术后镇痛，可稳定患者术后情绪，增强镇痛效果，降低阿片类药物的需要量及不良反应，患者术后满意度高，且未增加血管危象的发生率。Objective To investigate the effect of dexmedetomidine combined with sufentanil on postoperative analgesia and the vascular crisis in patients undergoing free flap transplantation. Methods Forty patients with ASA physical statusⅠ-Ⅱhaving underwent free flap transplantation were divided into groupⅠand groupⅡaccording to the random digits table method with 20 cases each. The drugs of patient controlled intravenous analgesia （PCIA） in groupⅠwere sufentanil 1.0μg/（kg·d）＋tropisetron 5 mg/100 ml, and the drugs of PCIA in group Ⅱ were sufentanil 1.0 μg/（kg · d） ＋dexmedetomidine 1.0 μg/（kg · d） ＋ tropisetron 5 mg/100 ml. The PCIA pump was set in 2 groups as follows： continuous perfusion rate 2 ml/h, single bolus 2 ml, lockout time 15 min. The visual analogue score （VAS）, Ramsay sedation score, press number of PCIA pump within 48 h after operation, satisfaction score after operation, untoward reaction and vascular crisis were recorded. Results The VAS at 6, 12, 24 and 48 h after operation in group Ⅱ were significantly lower than those in group Ⅰ： （2.18 ± 0.41） scores vs. （3.00 ± 0.63） scores, （2.64 ± 0.51） scores vs. （3.82 ± 0.60） scores, （2.55 ± 0.52） scores vs. （3.36 ± 0.51） scores and （2.27 ± 0.47） scores vs. （3.09 ± 0.70） scores, the Ramsay sedation scores were significantly higher than those in group Ⅰ： （2.42 ± 0.51） scores vs. （2.00 ± 0.58） scores, （2.74 ± 0.45） scores vs. （2.11 ± 0.57） scores, （2.58 ± 0.51） scores vs. （2.05 ± 0.52） scores and （2.53 ± 0.51） scores vs. （2.00 ± 0.47） scores, and there were statistical differences （P〈0.05）. The press number of PCIA pump within 48 h after operation in groupⅡwas significantly lower than that in groupⅠ：（3.75 ± 1.45） times vs. （8.25 ± 2.61） times, the satisfaction score after operation was significantly higher than that in groupⅠ：（2.47 ± 0.51） scores vs. （1.60 ± 0.50） scores, and there were statistical d

关 键 词：右美托咪啶 外科皮瓣 镇痛 血管危象 

分 类 号：R614[医药卫生—麻醉学]