右美托咪定复合盐酸羟考酮用于腹腔镜输尿管切开取石术后镇痛临床研究  

Clinical Study of Dexmedetomidine Combined with Oxycodone Hydrochloride for Postoperative Analgesia in Patients Undergoing Laparoscopic Ureterolithotomy

作　　者：胡正权[1] 刘大闯[1] 王梅[1] 周海[1] 江钦玉 HU Zhengquan;LIU Dachuang;WANG Mei;ZHOU Hai;JIANG Qinyu(Xuzhou Central Hospital,Xuzhou,Jiangsu,China 221009)

机构地区：[1]江苏省徐州市中心医院,江苏徐州221009

出　　处：《中国药业》2023年第4期87-91,共5页China Pharmaceuticals

基　　金：江苏省青年医学重点人才培养项目[QNRC2016389]。

摘　　要：目的探讨右美托咪定复合盐酸羟考酮用于腹腔镜输尿管切开取石术后镇痛的效果。方法选择医院泌尿外科病区2019年1月至2020年6月择期行腹腔镜输尿管切开取石手术的患者80例,按随机数字表法分为对照组和观察组,各40例。两组患者均依次静脉注射咪达唑仑注射液、依托咪酯注射液、枸橼酸舒芬太尼注射液和注射用苯磺顺阿曲库铵行麻醉诱导,诱导完毕后行气管插管和机械通气,术中静脉泵注丙泊酚注射液、注射用盐酸瑞芬太尼和间断给予注射用苯磺顺阿曲库铵维持麻醉。术毕前15min时连接患者自控静脉镇痛(PCIA)泵,其中对照组患者予盐酸羟考酮注射液1mg/kg+盐酸托烷司琼注射液5mg,观察组患者予盐酸羟考酮注射液0.6mg/kg+盐酸右美托咪定注射液3.8μg/kg+盐酸托烷司琼注射液5mg,均加入0.9%氯化钠注射液100mL稀释后使用。背景输注速率2mL/h,剂量0.5mL,锁定时间15min。视觉模拟(VAS)评分>4分时静脉注射地佐辛注射液5mg补救镇痛。结果两组患者手术时间、拔管时间、术中补液量、术中出血量,术后6,12,24,48h的平均动脉压、心率及皮肤瘙痒发生率均相当(P>0.05)。与对照组比较,观察组患者术后6,12,24,48h的血氧饱和度显著升高,VAS评分显著降低,Ramsay镇静评分显著升高,且术后12,24,48h的血清尿素氮、肌酐、皮质醇、内皮素-1水平均显著降低,尿量显著增多(P<0.05);观察组恶心、呕吐发生率及术后48 h内补救镇痛次数均显著低于对照组(P<0.05)。结论盐酸羟考酮与右美托咪定复合使用可有效缓解腹腔镜输尿管切开取石术后疼痛,改善患者肾功能,且效果优于其单用。ObjectiveTo investigate the effect of dexmedetomidine combined with oxycodone hydrochloride for postoperative analgesia in patients undergoing laparoscopic ureterolithotomy.MethodsA total of 80 patients underwent laparoscopic ureterolithotomy from January 2019 to June 2020 in the Urological Department of the hospital were selected and randomly divided into the control group and the observation group,with 40 cases in each group.The patients in the two groups were given Midazolam Injection,Etomidate Injection,Sufentanil Citrate Injection and Cisatracurium Benzenesulfonate Injection for anesthesia induction in turn.After induction,the patients underwent tracheal intubation and mechanical ventilation.During the operation,the patients were given Propofol Injection and Remifentanil Hydrochloride for Injection by intravenous pump,and intermittent injection of Cisatracurium Benzenesulfonate for Injection to maintain anesthesia.The patient-controlled intravenous analgesia(PCIA)pump was connected 15 min before the operation.The patients in the control group were given 1mg/kg of Oxycodone Hydrochloride Injection+5mg of Tropisetron Hydrochloride Injection,while the patients in the observation group were given 0.6mg/kg of Oxycodone Hydrochloride Injection+3.8μg/kg of Dexmedetomidine Hydrochloride Injection+5mg of Tropisetron Hydrochloride Injection,all of which were diluted with 100mL of 0.9% Sodium Chloride Injection.The background infusion rate was 2mL/h,the dose was 0.5mL,and the locking time was 15min.When visual analogue scale(VAS)score was higher than four points,the patient was given intravenous injection of 5mg of Diazosine Injection for rescue analgesia.ResultsThe operation time,extubation time,intraoperative fluid infusion volume,intraoperative bleeding volume,mean arterial pressure(MAP),heart rate(HR)and the incidence of skin pruritus at 6,12,24,48h after the operation in the two groups were similar(P>0.05).Compared with those in the control group,the blood oxygen saturation(SpO_(2))was significantly higher,VAS sc

关 键 词：右美托咪定 盐酸羟考酮 术后镇痛 腹腔镜手术 输尿管切开取石术 

分 类 号：R969.4[医药卫生—药理学] R971.2[医药卫生—药学]