不同剂量右美托咪定联合舒芬太尼用于妇科腹腔镜术后静脉自控镇痛的效果和安全性  

Efficacy and Safety of Different Doses of Dexmedetomidine Combined with Sufentanil in Application of Patient-controlled Analgesia after Gynecological Laparoscopic Surgery

作　　者：肖芳 张金立[2] 闫红丽[3] 许亚平 李爱军[2] 张欣 王磊 XIAO Fang;ZHANG Jin-li;YAN Hong-li;XU Ya-ping;LI Ai-jun;ZHANG Xin;WANG Lei(Department of Anesthesiology,Maternal and Child Health Hospital of Baoding,Baoding,Hebei 071051,China;Department of Anesthesiology,the First Central Hospital of Baoding,Baoding,Hebei 071051,China;Department of Scientific Research,the Affiliated Hospital of Hebei University,Baoding,Hebei 071000,China;Infection Control Office,Laishui County Hospital,Laishui,Hebei 074100,China;Department of Interventional Medicine,the Second Hospital of Baoding,Baoding,Hebei 071051,China)

机构地区：[1]保定市妇幼保健院麻醉科,河北保定071051 [2]保定市第一中心医院麻醉科,河北保定071051 [3]河北大学附属医院科研处,河北保定071000 [4]涞水县医院感染办,河北涞水074100 [5]保定市第二医院介入科,河北保定071051

出　　处：《临床误诊误治》2021年第8期52-58,共7页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划(20200269)。

摘　　要：目的探讨不同剂量右美托咪定(Dex)联合舒芬太尼(SF)对妇科腹腔镜术后自控镇痛的效果和安全性。方法选择2020年1—12月腹腔镜妇科术后行患者自控静脉镇痛(PCIA)者95例,根据Dex剂量不同分为C组31例、D1组32例、D2组32例。3组术后均行PCIA,C组给予SF 1μg/kg,D1组和D2组在C组基础上分别联合Dex 0.5和1μg/kg。评价3组麻醉清醒后(T0)、术后2 h(T1)、术后6 h(T2)、术后12 h(T3)、术后24 h(T4)血流动力学变化,以及疼痛视觉模拟评分(VAS)、Ramsay镇静评分、舒适度评分(BCS);记录镇痛泵按压次数、有效次数、泵注总量;评价围术期总睡眠时间和睡眠障碍指数(SPI)评分,并观察不良反应情况。结果T1~T3时,D1组和D2组的收缩压、舒张压、心率及VAS评分低于C组,且D2组低于D1组(P<0.05)。D1组和D2组术后24 h镇痛泵按压次数、有效次数、泵注总量低于C组(P<0.05)。T1~T3时,D1组和D2组BCS、Ramsay镇静评分高于C组,且D2组高于D1组(P<0.05)。手术当日,D2组总睡眠时间较D1组、C组长,D1组较C组长;SPI评分较D1组、C组低,D1组较C组低(P<0.05);D1组和D2组术后谵妄、恶心呕吐、寒战发生率低于C组(P<0.05)。结论Dex可增强妇科腹腔镜术后的镇痛、镇静效果,且血流动力学稳定,有较高的睡眠质量与舒适度,推荐PCIA时Dex与SF联合使用的最佳剂量为1μg/kg。Objective To investigate the efficacy and safety of different doses of Dexmedetomidine(Dex)combined with Sufentanil(SF)on patient-controlled intravenous analgesia(PCIA)after gynecological laparoscopic surgery.Methods A total of 95 patients receiving PCIA after gynecological laparoscopic surgery form January to December 2020 were enrolled in this study.According to different doses of Dex,the patients were divided into group C(n=31),group D1(n=32)and group D2(n=32).PCIA was given for all three groups after surgery,group C was given SF 1μg/kg,while group D1 and group D2 were combined with Dex 0.5μg/kg and Dex 1μg/kg respectively on the basis of treatment for group C.Among three groups,hemodynamic changes,and scores of visual analogue pain scale(VAS)and Ramsay Sedation Scale and Bruggrmann Comfort Scale(BCS)were evaluated after recovery from anesthesia(T0),at the 2 nd h(T1),at the 6 th h(T2),at the 12 th h(T3)and at the 24 th h(T4)after surgery;numbers of analgesic pump compression,effective numbers of times and the total volume of pump injection were recorded;the total perioperative sleep time and sleep disorder index(SPI)score were evaluated,and adverse reactions were observed.Results During T1-T3,values of systolic blood pressure,diastolic blood pressure,heart rate and VAS score in group D1 and D2 were significantly lower than those in group C,and the values in group D2 were significantly lower than those in group D1(P<0.05).Numbers of analgesic pump compression,effective numbers of times and the total volume of pump injections in postoperative 24 h in groups D1 and D2 were significantly lower than those in group C(P<0.05).During T1-T3,BCS and Ramsay sedation scores in group D1 and D2 were significantly higher than those in group C,and the scores in group D2 were significantly higher than those in group D1(P<0.05).On the day of surgery,the total sleep time in group D2 was significantly longer than those in group D1 and C,and the time in group D1 was longer than that in group C;SPI score in group D2 was lower th

关 键 词：右美托咪定 舒芬太尼 镇痛 病人控制 腹腔镜 血流动力学 睡眠 药物不良反应 

分 类 号：R459.9[医药卫生—治疗学]