右美托咪定超前镇痛应用于上肢骨折手术患者的术后镇痛效果观察  

Effect of preemptive analgesia with dexmedetomidin on the postoperative pain in patients undergoing upper limb fracture surgery

作　　者：占霖森[1] 兰允平[1] 夏昌兴[1] 余功敏[1] 邵雪泉[1] ZHAN Lin-sen;LAN Yun-ping;XIA Chang-xing(Department of Anesthesiology, Quzhou People＇s Hospital, Quzhou, Zhengjiang 324000, Chin)

机构地区：[1]衢州市人民医院麻醉科,浙江衢州324000

出　　处：《中华全科医学》2018年第7期1091-1093,共3页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2010KYB140)

摘　　要：目的探讨右美托咪定超前镇痛在上肢骨折手术中的应用价值。方法选取2015年3月—2017年6月接受手术治疗的上肢骨折患者106例为研究对象,以随机数字表法分为对照组53例、观察组53例,2组均采用气管插管全身麻醉,对照组麻醉前10 min泵注等剂量生理盐水,观察组麻醉前10 min泵注0.5μg/kg右美托咪定,术中泵注右美托嘧啶0.3μg/kg,观察2组手术结束前15 min(T_1)、术后3 h(T_2)、术后6 h(T_3)、术后12 h(T_4)血流动力学指标以及T_2、T_3、T_4时疼痛程度变化和不良反应发生情况。结果 2组T_1时血流动力学指标差异无统计学意义(P>0.05),观察组T_2、T_3、T_4时MAP、HR与T_1时比较差异无统计学意义(均P>0.05),对照组T_2、T_3、T_4时MAP、HR同观察组比较,明显较高,差异有统计学意义(均P<0.05);观察组T_2、T_3、T_4时VAS评分同对照组比较,明显较低,术后自控镇痛泵按压次数同对照组比较,明显较少,差异有统计学意义(均P<0.05);观察组术后不良反应发生率为9.43%,同对照组的24.53%相比,差异有统计学意义(P<0.05),2组均未出现严重不良反应。结论上肢骨折手术患者应用右美托咪定超前镇痛,可有效减轻术后疼痛,保持血流动力学稳定,减少术后静脉自控镇痛用药剂量,且安全性高,值得推广。Objective To explore the application value of preemptive analgesia with dexmedetomidin in the operation of upper limb fracture. Methods A total of 106 patients with upper limb fractures who underwent surgical treatment be- tween March, 2015 and June, 2017 were selected as the subjects. They were randomly divided into control group and ob- servation group with 53 cases in each group. The two groups were treated by general anesthesia with tracheal intubation. The control group was injected with isodose saline for 10 min before anesthesia, while the observation group pumped 0.5 g/kg fight Dexmedetomidine for 10min before anesthesia and intraoperative pump injection right beauty pyrimidine 0.3 μg/kg, and the hemodynamic parameters at 15 min before operation（ T1 ）, 3 h after operation（ T：2）, 6 h after operation （T3 ） and 12 h after operation（T4 ）, pain degree at T2, T3 and T4, and the adverse reactions were observed. Results At T1 , there was no significant difference in hemodynamic indexes between the two groups （ P 〉 0.05 ） , There was no significant difference of MAP and HR between the T2, T3, T4 and Tl in the observation group （ P 〉 0.05 ）. At T2, T3 and T4, MAP and HR in the control group were significantly higher than those in the observation group, and the differ- ence was statistically significant （ P 〈 0.05 ）. At T2, T3 and T4, VAS score of the observation group was significantly lower than that of the control group. The number of times of postoperative patient-controlled analgesia pump was signifi- cantly less than that of the control group （ P 〈 0.05 ）. The incidence of adverse reactions in the observation group was 9.43% , compared with 24.53% in the control group, the difference was statistically significant （ P 〈 0.05 ） , and no se- rious adverse reactions occurred in the two groups. Conclusion The application of Dexmedetomidine preemptive analge- sia in patients with upper limb fracture surgery can effectively reduce postoperative pain, maintain hemodynam

关 键 词：上肢骨折 手术 超前镇痛 右美托咪定 

分 类 号：R614.2[医药卫生—麻醉学] R683.41[医药卫生—外科学]