右美托咪定复合舒芬太尼在游离皮瓣移植术后中的应用研究  

Study on the application of dexmedetomidine combined with sufentanil in free skin flap transplantation

作　　者：张训功 张金良 孙帅[1] 刘瑶[1] ZHANG Xun-gong;ZHANG Jin-liang;SUN Shuai;LIU Yao(Department of Anesthesiology,Zhengzhou people's Hospital,Henan Province,450000,China;Department of Anesthesiology,The first people's Hospital of Zhengzhou,Henan Province,450000,China)

机构地区：[1]郑州人民医院麻醉科,河南郑州450000 [2]郑州市第一人民医院麻醉科,河南郑州450000

出　　处：《中国医疗美容》2020年第9期93-96,共4页China Medical Cosmetology

摘　　要：目的分析右美托咪定复合舒芬太尼在游离皮瓣移植术后中的应用效果。方法选取2018年1月~2019年1月我院行游离皮瓣移植术治疗的患者60例,随机数字表法分2组,各30例,均接受术后静脉自控镇痛(PCIA),A组PCIA药物为右美托咪定+舒芬太尼+托烷司琼,B组PCIA药物为舒芬太尼+托烷司琼,比较两组镇痛[术后6h、12h、24h、48h视觉模拟评分法(VAS)评分,麻醉前及术后1h、24h、48h、72h疼痛阈值]、镇静(术后6h、12h、24h、48h Ramsay镇静评分)、睡眠(术后1d、2d、3d匹斯堡睡眠质量指数量表(PSQI)评分)、不良反应与并发症发生情况。结果术后6h、12h、24h、48h A组VAS评分均低于B组(P<0.05);B组术后1h、24h、48h疼痛阈值较麻醉前降低(P<0.05),而A组各时间点疼痛阈值较麻醉前无明显变化(P>0.05),且术后1h、术后24h、术后48h A组疼痛阈值高于B组(P<0.05);术后6h、12h、24h、48h A组Ramsay镇静评分优于B组(P<0.05);术后1d、2d、3d A组PSQI评分均低于B组(P<0.05);两组不良反应与并发症发生率比较无显著差异(P>0.05)。结论右美托咪定复合舒芬太尼应用于游离皮瓣移植术后,未降低患者疼痛阈值,可增强术后镇痛效果,提高镇静作用,改善患者术后睡眠质量,且未增加不良反应与并发症,安全性好。Objective To analyze the effect of dexmedetomidine combined with sufentanil in free flap transplantation.Methods A total of 60 patients who underwent free skin flap transplantation in our hospital from January 2018 to January 2019 were selected.They were divided into 2 groups with random number table method,each with 30 cases.All received postoperative patient-controlled analgesia(PCIA).The PCIA drug in group A was dexmedetomidine+sufentanil+tropisetron,and the PCIA drug in group B was sufentanil+tropisetron.Comparing the analgesia[VAS score at 6h,12h,24h and 48h after surgery,pain threshold before anesthesia and 1h,24h,48h and 72h after surgery],sedation(Ramsay sedation score 6h,12h,24h,48h),sleep(Pittsburgh Sleep Quality Index(PSQI)score at 1d,2d,and 3d postoperatively),adverse reactions,and complications between the two groups.Results The VAS scores of group A were lower than group B at 6h,12h,24h and 48h after operation(P<0.05);the pain threshold of group B after 1h,24h and 48h was lower than that before anesthesia(P<0.05),however,the pain threshold at each time point in group A was not significantly different from that before anesthesia(P>0.05),and the pain threshold in group A was higher than that in group B at 1h,24h,and 48h(P<0.05);ramsay sedation score of group A was better than group B at 6h,12h,24h and 48h after operation(P<0.05);the PSQI scores of group A were lower than group B at 1d,2d,and 3d after operation(P<0.05);there was no significant difference in the incidence of adverse reactions and complications between the two groups(P>0.05).Conclusion Dexmedetomidine combined with sufentanil applied to free skin flap transplantation did not reduce the patient's pain threshold,it can enhance the postoperative analgesic effect and improve the sedative effect,improve the postoperative sleep quality of the patient,and does not increase adverse reactions and complications,and has good safety.

关 键 词：右美托咪定 舒芬太尼 游离皮瓣移植术 镇痛 疼痛阈值 镇静 

分 类 号：R614[医药卫生—麻醉学]