右美托咪定辅助舒芬太尼对胃癌术后静脉镇痛的剂量分析及对患者认知功能的影响  

The Dose Analysis and Effect of Dexmedetomidine Assisted Sufentanil on Intravenous Analgesia after Gastric Cancer Surgery

作　　者：李艳琼 赵建华[1] 魏磊[1] 杨芬[1] 吴一帆 LI Yanqiong;ZHAO Jianhua;WEI Lei;YANG Fen;WU Yifan(Department of Anesthesiology,Suzhou Municipal Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu,215000,China)

机构地区：[1]南京医科大学附属苏州市立医院麻醉科,江苏苏州215000

出　　处：《肿瘤药学》2018年第6期889-892,923,共5页Anti-Tumor Pharmacy

基　　金：国家自然科学基金资助项目(81171435)

摘　　要：目的探讨右美托咪定辅助舒芬太尼用于胃癌术后静脉镇痛的适合剂量及对患者术后认知功能的影响。方法选取在我院进行胃癌切除手术的患者118例作为研究对象,根据治疗方法不同分为对照组和研究组。对照组患者给予舒芬太尼3.0μg·kg-1(A组);研究组患者给予舒芬太尼联合右美托咪定(B组),并根据右美托咪定的不同剂量分为B1组(右美托咪定3.0μg·kg-1+舒芬太尼1.0μg·kg-1)、B2组(右美托咪定3.5μg·kg-1+舒芬太尼1.5μg·kg-1)、B3组(右美托咪定3.0μg·kg-1+舒芬太尼2.0μg·kg-1)。对比观察A、B两组患者不同时间段的镇痛评分(VAS)、Ramsay镇静评分以及B1、B2、B3三组的术后认知功能障碍情况,对比A、B两组患者手术前后炎性细胞因子水平以及术后不良反应的发生情况。结果 A、B两组患者不同时间段的镇痛评分无显著差异(P>0.05),B组患者镇静评分显著高于A组,其中B2组的镇静效果最好(P<0.05);B2组发生认知功能障碍的患者明显少于B1、B3组(P<0.05);A、B两组患者术前炎性细胞因子水平无明显差异(P>0.05),术后IL-6、TNF-Α水平明显升高,IL-10水平明显降低,且B组患者IL-6、TNF-α水平显著高于A组,IL-10水平显著低于A组,其中B2组各项指标的改善最为显著(P<0.05);不良反应发生率比较,B3组>A组>B1组>B2组,B3组的不良反应发生率最高(P<0.05)。结论右美托咪定联合舒芬太尼用于胃癌术后静脉镇痛的治疗效果好,最佳剂量为右美托咪定3.5μg·kg-1+舒芬太尼1.5μg·kg-1。Objective To explore the effects of different dosages of dexmedetomidine supplementation after gastric cancer surgery on intravenous analgesia and postoperative cognitive dysfunction of patients. Methods A total of 118 cases of gastric cancer resection in our hospital were selected as the research subjects. According to the treatment methods,the patients were divided into the control group and the obsearvation group. The control group was given sufentanil,named as group A,with a dose of 3.0 μg·kg^-1. Patients in the observation group were treated with sufentanil and dexmedetomidine,also named as group B. The group B was divided into three subgroups according to the dosage of dexmedetomidine. Group B1(dexmedetomidine 3.0 μg·kg^-1 + sufentanil 1.0 μg·kg^-1);group B2(dexmedetomidine 3.5 μg·kg^-1 + sufentanil 1.5 μg·kg^-1);group B3(dexmedetomidine 3.0 μg·kg^-1 + sufentanil 2.0 μg·kg^-1). The visual analogue scale (VAS) scores,Ramsay sedation scores and the changes of postoperative cognitive impairment in groups were compared. The changes of inflammatory cytokines were also observed and compared before and after the operation. The incidence of adverse reactions in all groups was compared. Results There was no significant difference in analgesic score between group A and B (P>0.05). The sedative score of the patients in group B was significantly higher than that in group A. What’s more,the sedative effect of group B2 was the best (P<0.05). Group B2 also had significantly less cognitive dysfunction cases than group B1 and B3(P<0.05). Before the operation,there was no significant difference in the level of each inflammatory cytokine between groups (P>0.05). But after operation,the levels of IL-6 and TNF-α in both group A and B increased significantly, and the level of IL-10 decreased significantly. The increase of IL-6 and TNF-α levels and the decrease of IL-10 level were greater in group B than in group A. Moreover,the levels of inflammatory cytokines had the most improvement in group B2(P<0.05). As fo

关 键 词：右美托咪定 舒芬太尼 镇痛 不同剂量 认知功能障碍 

分 类 号：R735.2[医药卫生—肿瘤]