右美托咪定混合舒芬太尼用于肝动脉化疗栓塞术PCIA的效果  

Efficacy of dexmedetomidine mixed with sufentanil for patient-controlled intravenous analgesia in patients undergoing transcatheter hepatic arterial chemoembolization

作　　者：王宏伟[1] 程黎娜[2] 艾艳秋[1] 李丽伟[1] 李治松[1] 储勤军[1] 管生[3] 张卫[1] Wang Hongwei;Cheng Lina;Ai Yanqiu;Li Liwei;Li Zhisong;Chu Qinjun;Guan Sheng;Zhang Wei(Department of Anesthesiology, First Affiliated Hospital of Zhengzhou University Key Laboratory of Medical Colleges of Henan Province, Zhengzhou 450052, Chin;Department of Gastroenterology, People＇s Hospital of Henan Province, Zhengzhou 450003, Chin;Department of lntervation, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Chin)

机构地区：[1]郑州大学第一附属医院麻醉科 河南省高等学校临床医学重点学科开放实验室,450052 [2]河南省人民医院消化内科,450003 [3]郑州大学第一附属医院介入科,450052

出　　处：《中华麻醉学杂志》2017年第12期1425-1428,共4页Chinese Journal of Anesthesiology

基　　金：河南省医学科技攻关项目（201602094）

摘　　要：目的评价右美托咪定混合舒芬太尼用于肝动脉化疗栓塞术PCIA的效果。方法择期监测麻醉下行肝动脉化疗栓塞术患者120例，年龄40～65岁，体重45～80 kg，性别不限，ASA分级Ⅰ-Ⅲ级，采用随机数字表法分为2组（n＝60）：舒芬太尼组（S组）和右美托咪定混合舒芬太尼组（DS组）。手术开始前15 min，2组均静脉注射舒芬太尼0.1 μg/kg和托烷司琼5 mg，DS组静脉输注右美托咪定0.6 μg/kg（给药时间15 min），S组给予等量生理盐水。S组PCIA药液配方：舒芬太尼2 μg/kg ＋托烷司琼5 mg；DS组PCIA药液配方：舒芬太尼2 μg/kg ＋右美托咪定2 μg/kg ＋托烷司琼5 mg，2组PCIA药液均用生理盐水稀释至100 ml。镇痛泵参数设置：背景输注速率2 ml/h，PCA剂量0.5 ml，锁定时间15 min。于术后30 min、2、6、12、24和48 h时记录OAA/S评分和患者镇痛满意度评分。记录PCIA按压次数、舒芬太尼总消耗量、吗啡补救用量；记录镇痛期间止吐药使用量、恶心呕吐、心动过缓、呼吸抑制和躁动的发生情况。结果与S组比较，DS组PCIA按压次数、舒芬太尼总消耗量和吗啡补救用量减少，患者镇痛满意度评分升高，OAA/S评分降低（P〈0.05），恶心呕吐、止吐药追加量、心动过缓、呼吸抑制、躁动的发生率差异无统计学意义（P〉0.05）。结论右美托咪定混合舒芬太尼用于肝动脉化疗栓塞术PCIA的效果优于单纯使用舒芬太尼。Objective To evaluate the efficacy of dexmedetomidine mixed with sufentanil for patient-controlled intravenous analgesia（PCIA）in the patients undergoing transcatheter hepatic arterial chemoembolization（TACE）.Methods One hundred and twenty patients of both sexes, aged 40-65 yr, weighing 45-80 kg, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective TACE under monitored anesthesia care, were divided into 2 groups（n=60 each）using a random number table： sufentanil group（S group）and dexmedetomidine mixed with sufentanil group（DS group）. At 15 min prior to surgery, 0.1 μg/kg sufentanil and 5 mg tropisetron were intravenously injected in both groups.In addition, dexmedetomidine 0.6 μg/kg was intravenously infused for 15 min in DS group, while the equal volume of normal saline was given instead in S group.PCIA solution contained sufentanil 2 μg/kg and tropisetron 5 mg in 100 ml of normal saline in S group.PCIA solution contained sufentanil 2 μg/kg, dexmedetomidine 2 μg/kg and tropisetron 5 mg in 100 ml of normal saline in DS group.The PCIA pump was programmed to deliver a 0.5 ml bolus dose with a lockout interval of 15 min and background infusion of 2 ml/h.Observer′s Assessment of Alertness/Sedation Scale scores and scores for patient′s satisfaction with analgesia were recorded at 30 min and 2, 6, 12, 24 and 48 h after surgery.The pressing times of PCIA, total consumption of sufentanil and requirement for morphine as rescue analgesics were recorded.The development of requirement for antiemetics, nausea and vomiting, bradycardia, respiratory depression and agitation was also recorded during analgesia.Results Compared with S group, the pressing times of PCIA, total consumption of sufentanil and requirement for morphine were significantly reduced, scores for satisfaction with analgesia were increased, and Observer′s Assessment of Alertness/Sedation Scale scores were decreased（P〈0.05）, and no significant change was found in the incidence of nausea and

关 键 词：右美托咪啶 舒芬太尼 肝动脉 栓塞 治疗性 镇痛 病人控制 

分 类 号：R614[医药卫生—麻醉学]