右美托咪定复合不同剂量舒芬太尼、地佐辛对直肠癌扩大根治术患者术后镇痛效果的临床观察  

Postoperative Analgesic Effect of Dextromidine,Shufentanil and Diazocinefor Enlarging Radical Surgery of Rectal Cancer

作　　者：翁晋晖[1] 李树鹏[1] 

机构地区：[1]山西省肿瘤医院麻醉科,山西太原030013

出　　处：《药品评价》2017年第22期43-45,51,共4页Drug Evaluation

摘　　要：目的:观察右美托咪定复合不同剂量舒芬太尼+地佐辛对直肠癌扩大根治术患者术后镇痛的效果。方法:选取我院择期行直肠癌扩大根治术患者60例,年龄45~65岁,ASAⅠ或Ⅱ级。随机均分为三组,每组均为20例,术后镇痛分别给予A组:舒芬太尼2μg/Kg+地佐辛0.3mg/Kg;B组:右美托咪定1.5μg/Kg+舒芬太尼1.5μg/Kg+地佐辛0.3mg/Kg;C组:右美托咪定1.5μg/Kg+舒芬太尼1μg/Kg+地佐辛0.3mg/Kg。三组麻醉诱导:静注丙泊酚1.8mg/kg、舒芬太尼0.6μg/Kg、顺式阿曲库铵0.3mg/kg,于手术结束后连接静脉镇痛泵行患者自控静脉镇痛(Patient controlled intravenous analgesia,PCIA),背景输注流速2m L/h,单次追加药量0.5m L,锁定时间15min,总容量80m L。分别记录三组患者术后1h(T1)、3h(T2)、6h(T3)、12h(T4)、24h(T5)的疼痛视觉模拟评分(Visual analogue scale,VAS疼痛评分)、Ramsay评分(镇静评分)和PONV评分(恶心、呕吐评分)。结果:T1~T5时A、B、C三组VAS评分:B组低于A组(P<0.05),A组、C组差异无统计学意义;R a m s a y镇静评分:A、B、C三组差异无统计学意义;P O N V恶心、呕吐评分:C组低于A组(P<0.05);A组、B组差异无统计学意义。结论:1.5μg/Kg右美托咪定复合1~2μg/Kg舒芬太尼+0.3mg/Kg地佐辛(总容量80m L,输注流速2m L/h)用于直肠癌根治术术后镇痛、镇静效果良好,右美托咪定+地佐辛复合使用可减少舒芬太尼的用量,同时降低其恶心呕吐等不良反应的发生率。ObjectiveTo observe the effect of dexmetomidine,Shufentanil and diazocine on the postoperative analgesia in patients with enlargingradical surgery for rectal cancer. Methods： 60 patients（age 45 to 65 yearsold,ASA Ⅰ or Ⅱ level）with enlarging radical surgery for rectal cancerwererandomly divided into three groups, each with 20 cases, and the postoperative analgesia was given to group A： shufentanyi 2μg/Kg＋diazxin 0.3mg/Kg; Group B： dexmeidine 1.5μg/Kg＋difentanil 1.5μg/Kg＋diazosin 0.3mg/Kg; Group C： dexmeidine 1.5μg/Kg＋sufentanyl 1μg/Kg＋diazocine0.3mg/Kg. Three groups of anesthesia induction： propofol intravenous administration of 1.8mg/kg, sufentanil 0.6μg/kg, cis atracurium 0.3mg/kg, inoperation after the connection line of self-control vein analgesia in patients with venous analgesia pump （patient controlled intravenous analgesia,PCIA）, background infusion velocity of 2 mL/h, a single additional doses of 0.5 mL, locking time 15 min, the total capacity of 80 mL. Record thethree groups of patients with postoperative 1 h （T1）, 3 h （T2） （T3）, 6 h, 12 h （T4）, 24 h （T5） VAS pain score （visual analogue scale, visual analogpain score）, Ramsay grade （sedation score） and PONV （nausea, vomiting, score）. Results： A, B, and C three groups of VAS were scored： group B waslower than group A （P〈0.05）, and there was no significant difference between group A and group C. Ramsay sedation scores： A, B, and C were notstatistically significant, PONV nausea, and vomiting score C were lower than group A （P〈0.05）. There was no significant difference between group Aand group B. Conclusion： 1.5μg/Kg dexmetomidine,1 ~ 2μg/Kg sufentanil＋0.3mg/Kg assist sheen （total capacity of 80 mL, infusion velocity of 2 mL/h）showed good sedation effect for postoperative analgesia; dexmetomidine＋assist sheen can reduce the dosage of sufentanil, at the same time reduce theincidence of adverse reactions such as nausea and vomiting.

关 键 词：右美托咪定 舒芬太尼 地佐辛 直肠癌扩大根治术 镇痛 

分 类 号：R614[医药卫生—麻醉学] R735.37[医药卫生—外科学]