右美托咪定联合酮咯酸氨丁三醇术前给药对胸腔镜手术肺癌患者镇痛和镇静效果的影响  

Effect of Preoperative Administration of Dexmedetomidine Combined with Ketorolac Tromethamine on Analgesia and Sedation in Patients with Lung Cancer Undergoing Thoracoscopic Surgery

作　　者：李国锋 蒋文帅 刘新峰 徐姣 LI Guo-feng;JIANG Wen-shuai;LIU Xin-feng;XU Jiao(Department of Anesthesiology,Occupational Disease Prevention Hospital of China Pingmei Shenma Group,Pingdingshan 467099,China;School of Biomedical Engineering,Xinxiang Medical University,Xinxiang 453003,China;Pingmei Shenma Medical Group General Hospital,Pingdingshan 467000,China)

机构地区：[1]中国平煤神马集团职业病防治院麻醉科,平顶山467099 [2]新乡医学院生物医学工程学院,新乡453003 [3]平煤神马医疗集团总医院,平顶山467000

出　　处：《中国合理用药探索》2021年第12期90-94,共5页Chinese Journal of Rational Drug Use

基　　金：国家自然科学基金资助项目(8157120801)。

摘　　要：目的:探讨右美托咪定联合酮咯酸氨丁三醇术前给药对胸腔镜手术肺癌患者镇痛和镇静效果的影响。方法:选择2018年1月~2020年1月于本院接受胸腔镜手术治疗的108例肺癌患者作为研究对象,按照随机数字表法将其分为观察组和对照组,各54例。观察组患者于术前静脉泵注0.4μg/kg盐酸右美托咪定注射液+0.2 mg/kg酮咯酸氨丁三醇注射液,手术结束前10 min快速注射2 ml镇痛液(0.05μg/kg盐酸右美托咪定注射液+0.025 mg/kg酮咯酸氨丁三醇注射液,用氯化钠注射液稀释至100 ml)。对照组患者于手术结束前10 min快速注射2 ml镇痛液。比较两组患者恢复期各项指标(自主呼吸恢复时间、苏醒时间、定向力恢复时间、拔管时间);采用视觉模拟评分(VAS)和Ramasy评分分别评估两组患者术后4、8、12、24、48 h的疼痛程度和镇静程度;测定两组患者术前和术后48 h血清疼痛介质[前列腺素E 2(PGE 2)、P物质(SP)、降钙素基因相关肽(CGRP)、神经肽Y(NPY)]水平;统计并发症发生情况。结果:观察组自主呼吸恢复时间短于对照组(P<0.05);两组苏醒时间、定向力恢复时间和拔管时间比较无统计学差异(P>0.05)。术后4、8 h,观察组VAS评分低于对照组(P<0.05);术后12、24、48 h,两组VAS评分比较无统计学差异(P>0.05)。术后4、8 h,观察组Ramasy评分高于对照组(P<0.05);术后12、24、48 h,两组Ramasy评分比较无统计学差异(P>0.05)。术前,两组血清PGE 2、SP、CGRP、NPY水平比较无统计学差异(P>0.05);术后48 h,观察组血清PGE 2、SP、CGRP、NPY水平低于对照组(P<0.05)。两组并发症总发生率比较无统计学差异(P>0.05)。结论:右美托咪定联合酮咯酸氨丁三醇术前给药可促进胸腔镜手术肺癌患者术后恢复,提高镇痛效果,使患者术后短期内镇静程度更高,安全性好。Objective:To explore the effect of preoperative administration of dexmedetomidine combined with ketorolac tromethamine on analgesia and sedation in patients with lung cancer undergoing thoracoscopic surgery.Methods:A total of 108 lung cancer patients who underwent thoracoscopic surgery in our hospital from January 2018 to January 2020 were selected as the research subjects.According to the random number table method,they were divided into the observation group and the control group,with 54 cases in each.Patients in the observation group were given intravenous pump injection of 0.4μg/kg dexmedetomidine hydrochloride injection+0.2 mg/kg ketorolac tromethamine injection before operation.2 ml analgesic solution(0.05μg/kg dexmedetomidine hydrochloride injection+0.025 mg/kg ketorolac tromethamine injection,diluted to 100 ml with sodium chloride injection)was quickly injected 10 min before the end of surgery.The patients in the control group were injected with 2 ml analgesic solution 10 min before the end of operation.Various indicators in the two groups during the recovery period(recovery time of spontaneous breathing,recovery time,recovery time of directional force and extubation time).Visual analog scale(VAS)and Ramasy score were used to evaluate the degree of pain and sedation of the two groups at 4,8,12,24 and 48 h after operation.The levels of serum pain mediators[prostaglandin E 2(PGE 2),substance P(SP),calcitonin generelated peptide(CGRP),neuropeptide Y(NPY)]were measured before and 48 h after operation.The incidence of complications was counted.Results:The recovery time of spontaneous breathing in the observation group was shorter than that in the control group(P<0.05),and there was no significant difference in recovery time,recovery time of directional force and extubation time between two groups(P>0.05).At 4 and 8 h after operation,the VAS score of the observation group was lower than that of the control group(P<0.05),and at 12,24,and 48 h after operation,there was no significant difference in the VAS score

关 键 词：右美托咪定 酮咯酸氨丁三醇 术前给药 胸腔镜手术 疼痛介质 

分 类 号：R974[医药卫生—药品]