右美托咪定复合地佐辛术后镇痛对胸腔镜肺叶切除术患者睡眠质量及炎性反应的影响  

Effects of dexmedetomidine combined with dezocine on sleep quality and inflammatory response in patients undergoing thoracoscopic lobectomy

作　　者：胡晓云[1] 赵斌江[1] 刘鹏飞[1] 李天佐[1] HU Xiaoyun;ZHAO Binjiang;LIU Pengfei;LI Tianzuo(Department of Anesthesiology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院麻醉科,北京100038

出　　处：《实用医学杂志》2019年第2期299-302,共4页The Journal of Practical Medicine

摘　　要：目的观察右美托咪定复合地佐辛术后镇痛对胸腔镜肺叶切除术患者睡眠质量及炎性反应的影响。方法选择120例择期全麻下胸腔镜肺叶切除术患者,随机分为实验组和对照组,每组60例。两组患者手术结束前行肋间神经阻滞,术后接PCIA恩丹司琼8 mg+生理盐水至100 mL。对照组为地佐辛1 mg/kg+恩丹司琼8 mg+生理盐水至100 mL。两组背景输注流速为2 mL/h,单次追加1 mL/次,锁定时间15 min。采用阿森失眠量表评估患者术前晚和术后第1、2、3天睡眠情况;记录术后4、12、24和48 h VAS评分,PCIA按压次数及地佐辛消耗量、芬太尼补救剂量;记录不良反应发生情况。于麻醉前、术后4、24和48 h采集外周血,以ELISA法测定CRP、IL-6浓度。结果术后第1、2、3天实验组AIS评分均较对照组明显降低(P <0.05)。各时点实验组血清CRP、IL-6水平均低于对照组水平(P <0.05)。实验组术后各时点VAS评分,术后PCIA良反应发生率均明显低于对照组(P <0.05)。结论右美托咪定复合地佐辛用于胸腔镜肺叶切除术患者术后镇痛,能达到良好镇痛的同时,改善患者的睡眠质量,并在一定程度上减轻炎性反应和术后不良反应。Objective To observe the effects of dexmedetomidine combined with dezocine on sleep quality and inflammatory response in patients undergoing thoracoscopic lobectomy.Methods 120 patients with thoracic surgery were randomly and averagely divided into two groups,including experimental group and control group.All the patients underwent intercostals neural blockade with ropivacaine before the end of surgery.The patients in ex perimental group received PCIA(with total volume 100 mL,containing 3μg/kg dexmedetomidine,1 mg/kg dezo cine,8 mg ondansetron and 0.9%normal saline)after operation,while the control group received PCIA(with to tal volume 100 mL,containing 1 mg/kg dezocine,8 mg ondansetron and 0.9%normal saline)after operation.The background infusion rate of the two analgesia pumps were both set at 2 mL/h,and single dose was 1 mL with inter val time 15 min.The sleep quality was assessed by Athens insomnia scale before surgery and 1 d,2 d,3 d after surgery.VAS scores,the number of PCIA presses,consumption of dezocine and fentanyl,the serum level of CRP and IL-6 were assessed and recoded at 4,12,24,48 h after surgery.Besides,the adverse effects were recorded.Results Compared with the control group at all the time points after surgery,in the experimental group,the sleep quality improved greatly(P<0.05),the VAS scores and the serum level of IL-6 and CRP decreased significantly(P<0.05),both the consumption of dezocine,fentanyl and the occurrence of adverse effects reduced obviously(P<0.05).Conclusion Patient-controlled intravenous analgesia with dexmedetomidine and dezocine could effec tively alleviate pain after surgery,and inhibit postoperative inflammation and side effects.

关 键 词：右美托咪定 地佐辛 镇痛 睡眠质量 胸腔镜手术 炎性反应 

分 类 号：R614.2[医药卫生—麻醉学]