混合氟比洛芬酯和布托啡诺时右美托咪定用于开腹肠肿瘤根治术后静脉镇痛的适宜剂量  

Optimal dose of dexmedetomidine for intravenous analgesia after open radical resection of intestinal neoplasms when mixed with flurbiprofen axetil and butorphanol

作　　者：刘婷[1] 彭书岐[1] 李玉希[2] 李玉娟[1] 杨涛[1] 

机构地区：[1]中山大学孙逸仙纪念医院麻醉科,广州市510120 [2]中山大学孙逸仙纪念医院骨外科,广州市510120

出　　处：《中华麻醉学杂志》2017年第6期681-683,共3页Chinese Journal of Anesthesiology

基　　金：广东省省级科技计划项目（2014A020212147）

摘　　要：【摘要】目的确定混合氟比洛芬酯和布托啡诺时右美托咪定用于开腹肠肿瘤根治术后静脉镇痛的适宜剂量。方法择期开腹肠肿瘤根治术患者120例，性别不限，ASA分级I或Ⅱ级，年龄20～60岁，体重45～80kg，采用随机数字表法分为对照组（C组）和不同剂量右美托咪定组（DEXl组、DEX2组和DEX3组），每组30例。C组用氟比洛芬酯2mg／kg和布托啡诺0．05mg／kg静脉镇痛；DEX1组、DEX2组和DEX3组在术毕前30min开始静脉输注右美托咪定0．5μg／kg，镇痛泵配方分别用右美托咪定1、2、3μg／kg混合氟比洛芬酯2mg／kg和布托啡诺0．05mg／kg，用0．9％生理盐水配成100ml，2ml／h。术后静脉注射布托啡诺0．5mg用于镇痛补救，采用咳嗽时VAS评分法评估术后疼痛程度，维持VAS评分〈4分。记录术后48h内镇痛补救情况，记录术后恶心、呕吐、呼吸抑制、嗜睡、心动过缓、低血压、镇静过度等的发生情况，记录镇痛满意度和术后住院时间。结果与C组比较，DEX2组和DEX3组术后镇痛补救率减少，镇痛满意度增加，DEX3组术后嗜睡发生率增加（P〈0．05）。DEXl组、DEX2组和DEX3组未见其他不良反应发生。结论混合氟比洛芬酯和布托啡诺时右美托咪定用于开腹肠肿瘤根治术后静脉镇痛的适宜剂量为2μg／kg。Objective To determine the optimal dose of dexmedetomidine for intravenous analgesia after open radical resection of intestinal neoplasms when mixed with flurbiprofen axetil and butorphanol. Methods A total of 120 patients of both sexes, of American Society of Anesthesiologists physical status I or ]I , aged 20-60 yr, weighing 45-80 kg, undergoing elective open radical resection of intestinal neo- plasms, were divided into 4 groups （n = 30 each） using a random number table： control group （ group C） and different doses of dexmedetomidine groups （group DEX1, group DEX2, group DEX3）. Group C re- ceived flnrhiprofen axetil 2 mg/kg and butorphanol 0. 05 mg/kg for intravenous analgesia. In DEX1, DEX2 and DEX3 groups, dexmedetomidine 0.3 μg/kg was intravenously infused starting from 30 min before the end of surgery, and the analgesia solution contained dexmedetomidinc 1, 2 and 3 μg/kg, respectively, which was mixed with flurbiprofen axetil 2 mg/kg and butorphanol 0. 05 mg/kg in 100 ml of 0.9% normal saline, and the mixture was infused at a rate of 2 ml/h. Butorphanol 0.5 mg was intravenously injected as a rescue analgesic, postoperative pain was assessed using tile visual analog scale at coughing, and visual all- alog scale score was maintained 〈4. The requirement fur rescue analgesics was recorded within 48 h aD.er operation. Tire occurrence of postoperative adverse reactions such as nausea and wmfiting, respiralory de- pression, somnolence, bradycardia, hypotension and over-sedation, patient＇s satisfaction with analgesia and length of postoperative hospital stay were recorded. Results Compared with group C, the rate of res- cue analgesia after operation was signifieantly decreased, and the degree of satisfaction with analgesia was increased in DEX2 and DEX3 groups, and the incidence of postoperative somnolence was significantly in- ereased in group DEX3 （P〈0.05）. No other adverse effects were found in DEX1, DEX2 and DEX3 groups. Conclusion When mixed with flurbiprofen axetiL and bmurphanol,

关 键 词：右美托咪啶 氟比洛芬 布托啡诺 肠肿瘤 剖腹术 镇痛 

分 类 号：R614[医药卫生—麻醉学] R735.3[医药卫生—外科学]