右旋美托嘧啶复合PCIA在腭咽成形术后带管患者镇痛效果观察  

The analgesia effect of dexmedetomidine combined with PCIA for patients carrying tube after palatopharyngoplasty

作　　者：梁宁[1] 陈萍[1] LIANG Ning(Chongqing Medical University, Chongqing , 400016, China)

机构地区：[1]重庆医科大学附属第一医院,400016

出　　处：《齐齐哈尔医学院学报》2016年第33期4113-4116,共4页Journal of Qiqihar Medical University

基　　金：国家临床重点专科资助项目(财社[2011]170号)

摘　　要：目的探讨右旋美托嘧啶复合PCIA在重度阻塞性睡眠呼吸暂停综合征行腭咽成形术后带管患者的镇痛效果。方法 80例腭咽成形术后带管患者随机分为4组,每组20例。D1组于手术结束前15分钟将丙泊酚改为泵注右旋美托嘧啶直至拔出气管导管;D2组于术毕安置PCIA（曲马多、氟比洛芬酯）;D3组右旋美托嘧啶辅以PCIA;D4组泵注等量生理盐水并根据疼痛情况单次给予镇痛药物。观察患者可唤醒时间、出PACU时间,在术毕前15分钟（T1）、术毕时（T2）、可唤醒患者时（T3）、出PACU时（T4）、回病房后1 h（T5）、拔管前1 h（T6）、拔管后（T7）共7个时间点观察血流动力学指标,比较T3～T7各时间点镇静评分（Ramsay评分）、镇痛评分（VAS评分）差异,比较患者术毕至拔出气管导管期间不良反应。结果患者可唤醒时间、出PACU时间比较无差异（P〉0.05）;在T3～T7时间点,D1、D2、D3组平均动脉压（MAP）、心率（HR）显著低于D4组（P〈0.05）,而D2组MAP显著低高于D1、D3组（P〈0.05）;T3～T7时间点,D1、D2、D3组Ramsay评分显著高于D4组（P〈0.05）,而D3组Ramsay评分显著高于D1、D2组（P〈0.05）;T3～T7时间点,D3组VAS评分评分显著低于D1、D2、D4组（P〈0.05）,而D1、D2显著低于D4组（P〈0.05）;4组患者不良反应发生无差异（P〈0.05）。结论右旋美托咪啶辅以曲马多和氟比洛芬酯配置的PCIA可以有效减少腭咽成形术后带管患者的疼痛,使血流动力学更加平稳,且不增加呼吸抑制、过度镇静等并发症的发生。Objective To investigate the analgesia effect of dexmedetomidine combined with PCIA for patients carrying tube after palatopharyngoplasty.Methods 80 patients with tube after palatopharyngoplasty were randomly divided into 4 groups,20 cases in each group. In D1 group,15 minutes before the end of operation dexmedetomidine replace propofol infusion until the endotracheal tube pulled out. D2 group at the end of surgery placed PCIA（ tramadol,flurbiprofen）. Group D3 was treated with dexmedetomidine combined with PCIA. The D4 group was injected with the same amount of normal saline and given analgesic drugs according to the pain. Observe the time of wake up and the occurrence of the PACU in patients,hemodynamic parameters were observed at 15 minutes before surgery（ T1）,after the completion of the surgery（ T2）,the wake up（ T3）,the PACU（ T4）,back to the ward after 1h（ T5）,1h before extubation（ T6）,after extubation（ T7）,compare the difference of Ramsay score and VAS score at each time point of T3-T7,and the adverse reactions were compared. Results There was no difference in waking time and leave PACU time between the patients（ P〉0.05）. MAP and HR of D1,D2 and D3 group was significantly lower than the D4 group（ P〈0. 05）,but MAP of D2 was significantly lower than the D1 and D3 group（ P〈0. 05）. Between T3 ～ T7,the ramsay score of D1,D2,D3 group was significantly higher than the D4 group（ P〈0. 05）,and the D3 group was significantly higher than the D1,D2 group（ P〈0.05）. Between T3 ～ T7,the VAS score of D1,D2,D3 group was significantly lower than the D4 group（ P〈0.05）,and the D3 group was significantly lower than the D1,D2 and D4 group（ P〈0.05）,and D1 and D2 group significantly lower than the D4 group. There was no difference in adverse reactions between the 4 groups.Conclusions Dexmedetomidine combined with PCIA can effectively reduce the pain of patients with tube after jaw forming,make the hemodynamics more stable,and does not increase the occurrenc

关 键 词：阻塞性睡眠呼吸暂停综合征 右旋美托嘧啶 PCIA 腭咽成形术 镇痛 

分 类 号：R971.93[医药卫生—药品]