单次不同剂量地佐辛与右美托咪定联合用于硬膜外镇痛的效果评价  

Effects of different-doses of dezocine and dexmedetomidine through single epidural injection on postoperative patient-controlled epidural analgesia

作　　者：杨云菲 李荣[1] 王东[1] 陈彪[1] 吴娟[1] YANG Yunfei;LI Rong;WANG Dong;CHEN Biao;WU Juan(The First Affiliated Hospital of Baotou Medical College,Baotou 014010,China)

机构地区：[1]内蒙古科技大学包头医学院第一附属医院麻醉科

出　　处：《包头医学院学报》2019年第9期10-12,40,共4页Journal of Baotou Medical College

基　　金：秦文斌科技教育基金(BJYY-QWB 201706)

摘　　要：目的:观察不同剂量地佐辛与右美托咪定(Dex)联合单次硬膜外注射对0.2%罗哌卡因术后硬膜外镇痛(PCEA)效果的影响。方法:择期腹式全子宫切除患者120例(ASA分级1-2级)患者,随机分为4组,分别为C组、D1组、D2组和D3组,每组30例患者;4组患者PCA泵内药物配方均为0.2%罗哌卡因药液100 mL;PCEA镇痛泵的模式均为:持续输注剂量(cl)1 mL加单次自控按压剂量(Blous)2 mL,锁定时间15 min,镇痛48 h。LD均配置为5 mL溶液;C组LD镇痛液为7 mg地佐辛;D1组为地佐辛5mg加Dex 0.3μg/kg;D2组为地佐辛3mg加Dex 0.4μg/kg;D3组为地佐辛2mg+Dex 0.5ug/kg;观察各组患者硬膜外用药量,运动阻滞功能恢复至0级的时间,各时段VAS评分,Ramesay镇静评分,改良Bromage分级,并记录不良反应的发生情况。结果:4组患者术后4 h的VAS评分均较低,4~12 h时段VAS评分均上升,且在4~8 h时段达到高峰;实验组(D1组,D2组,D3组)各时段的VAS评分与同时段的对照组(C组)相比有差异(P<0.05);D2组各时段的VAS评分低于同时段的D1组,D3组(P<0.05);而D1组与D3组之间相比,差异无统计学意义(P>0.05);D3组运动恢复时间比C组延长(P<0.05);D1组、D2组、D3组恶心、呕吐和寒战发生率低于C组(P<0.05)。结论:单次硬膜外注射地佐辛3 mg与Dex剂量0.4μg/kg的负荷剂量并联合0.2%罗哌卡因PCEA用于开腹全子宫切除术可获得良好的镇痛效果,患者满意度较高,可在临床应用。Objective:To observe the analgesic effects and adverse reactions of different-doses of dexemedetomidineand dezocinethrough single epidural injection on postoperative patient-controlled epidural analgesia(PCEA)using0.2%ropivacaine after transabdominal hysterectomy.Methods:120 ASA GradeⅠ-Ⅱlevel patients undergoing transabdominal hysterectomy were randomly divided into four groups:Groups C,D1,D2,D3,of30 cases each.Patients in the four groups all received PCEA using 0.2%ropivacaine.The mode of PCA in all of the four groups was LCP with loading dose(LD)5 m L+background infusion dose(CI)1 m L+bolus dose 2 m L,with lockout intervals of 1minutes within 48 hours posteroperatively.LD in Group C wasdezocine7mg,dezocine 5mg+Dex 0.3μg/kg in Group D1,dezocine 3mg+Dex 0.4μg/kg in Group D2,dezocine 2mg+Dex 0.5μg/kg in Group D3.The VAS scores of wound pain in 4h,6h,8h,12h,24h,48hafter PCA initiation,Ramsay sedation scoreandBromage score wererecorded.Results:The VAS scores of wound pain in Groups D1,D2,D3 were lower than that in Group C in all the time(P<0.05),while that in Group D2 was lower than that in Group D1 andD3 in all time.The number of bolus doses in Groups D2 and D3 was less than that in Groups C and D1 during 4~12h(P<0.05).The incidence of postoperative nausea and vomiting and shivering in Groups D1,D2,D3 was lower than those in groupC(P<0.05).Conclusion:Dexmedetomidineand dezocinegiven through single epidural injection improves analgesic effects of PCEA using ropivacaine after transabdominal hysterectomy,and also reduces adverse reactions.Dexmedetomidine at 0.4μg/kg and dezocine at 3mg was the best recommended dose in clinical practice.

关 键 词：地佐辛 右美托咪定 罗哌卡因 硬膜外镇痛 

分 类 号：R61[医药卫生—外科学]