右美托咪定复合羟考酮在妇科老年患者腹腔镜手术中的应用效果  

Dexmedetomidine Combined with Oxycodone in Older Patients Undergoing Gynecological Laparoscopic Surgery

作　　者：刘旺生 贝筝 Liu Wangsheng;Bei Zheng(Depatment of Anesthesiology,Hainan Modern Womens and Childrens Hospital,Haikou 570100;Department of Neurology,Hainan Provincial Cadre Sanatorium,Haikou 570100)

机构地区：[1]海南现代妇女儿童医院麻醉科,海口570100 [2]海南省干部疗养院神经内科,海口570100

出　　处：《国际老年医学杂志》2022年第2期211-215,共5页International Journal of Geriatrics

基　　金：海南省自然科学基金(817373)。

摘　　要：目的探讨右美托咪定复合羟考酮对行腹腔镜手术的妇科老年患者的镇痛效果及对血清皮质醇(Cor)和人白细胞DR抗原(HLA-DR)表达的影响。方法选取2018年2月~2019年8月接受腹腔镜手术治疗的120例老年妇科病患者作为研究对象,采用随机数字表法分为研究组和对照组各60例,对照组术后给予羟考酮镇痛,研究组术后给予右美托咪定复合羟考酮镇痛。观察两组患者的疼痛视觉模拟(VAS)评分、Ramsay镇静评分、睡眠质量评分、血清Cor水平和HLA-DR表达情况,以及术后不良反应。结果研究组术后2、6、12、24和48h的VAS评分和Ramsay镇静评分均低于对照组,差异有统计学意义(P<0.05);研究组术后第1夜、第2夜的主观睡眠质量评分高于对照组,术后1周平均每日睡眠时间长于对照组,术后1周睡眠障碍指数(SPI)低于对照组,差异均有统计学意义(P<0.05);研究组术毕、术后5h、术后第1d8:00及术后第2d8:00各时间点的血清Cor水平均低于对照组,研究组血清HLA-DR表达在术后5h、术后第1d8:00及术后第2d8:00均高于对照组,差异均有统计学意义(P<0.05);术后两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定复合羟考酮能够显著改善行腹腔镜手术的妇科老年患者术后的镇痛、镇静评分,降低机体应激反应,调节机体免疫功能,值得在临床推广。Objective To investigate the effects of dexmedetomidine combined with oxycodone on analgesia and the levels of serum cortisol(Cor) and human leukocyte antigen-DR(HLA-DR) in older patients undergoing gynecological laparoscopic surgery.Methods A total of 120 older patients who underwent gynecological laparoscopic surgery from February 2018 to August 2019 were selected and divided into the research group and the control group by random number table, 60 cases in each group.Patients in the control group were treated with oxycodone alone for analgesia, and patients in the research group were treated with dexmedetomidine combined with oxycodone.The scores of visual analogue pain(VAS),ramsay sedation and sleep quality were evaluated.The levels of serum cortisol and HLA-DR,and postoperative adverse reactions were investigated in both groups.Results In the research group, the scores of VAS and ramsay sedation at 2,6,12,24 and 48 hours after surgery were much lower than those in the control group(P<0.05).In the research group, the scores of sleep quality on the first and second night after surgery were significantly higher, the average daily sleep time 1 week after surgery was longer, and sleep disorder index(SPI) was significantly lower than those in the control group;the differences were statistically significant(P<0.05).In the research group, the serum Cor levels were lower than those in the control group at the end of surgery, 5 hours after surgery, at 8:00 on the first and second day after surgery;and the serum HLA-DR levels were higher than those in the control group 5 hours after surgery, at 8:00 on the first and second day after surgery;the differences were statistically significant(P<0.05).There was no significant difference in the rate of adverse reactions between the two groups(P>0.05).Conclusion Dexmedetomidine combined with oxycodone may significantly improve postoperative analgesia and sedation effects in older patients undergoing gynecological laparoscopic surgery, reduce the stress response, and regulate the

关 键 词：右美托咪定 羟考酮 腹腔镜 皮质醇 人白细胞DR抗原 

分 类 号：R614[医药卫生—麻醉学]