腹腔镜肝切除术治疗原发性肝癌患者应用右美托咪定复合布托啡诺术后镇痛效果研究  

Post-operational alanalgesia of dexmedetomidine and butorphanol combination in patients with primary liver cancer after laparoscopic hepatectomy

作　　者：楼鹏 邓继红 严铭一 Lou Peng;Deng Jihong;Yan Mingyi(Department of Anesthesia,Rehabilitation Hospital Affiliated to Nantong University,Nantong 226000,Jiangsu Province,China)

机构地区：[1]南通大学附属康复医院麻醉科,江苏省南通市226000

出　　处：《实用肝脏病杂志》2023年第6期899-902,共4页Journal of Practical Hepatology

基　　金：2020年南通市科技计划研究项目(编号:MSZ20128)。

摘　　要：目的探讨应用右美托咪定(DEX)复合布托啡诺(BUT)对腹腔镜肝切除术(LH)治疗的原发性肝癌(PLC)患者麻醉苏醒和术后疼痛的影响。方法2019年1月~2022年10月我院诊治的PLC患者74例,随机分为对照组37例和观察组37例,均择期行LH治疗。在术后镇痛时,分别采取舒芬太尼(SUF)复合BUT或Dex复合BUT镇痛泵持续静脉泵入。采用疼痛视觉模拟评分(VAS)评价术后疼痛程度,采用Ramsay镇静评分【11】量表评价术后镇痛效果。结果观察组手术时间和麻醉时间分别为(210.4±20.2)min和(228.7±30.6)min,与对照组【分别为(208.1±28.3)min和(226.5±32.9)min】比,差异无统计学意义(P>0.05),而观察组自主呼吸恢复时间和苏醒时间分别为(15.5±3.1)min和(18.2±4.3)min,均显著短于对照组【分别为(20.3±4.9)min和(22.9±4.9)min,P<0.05】;在术后4 h、24 h和48 h,观察组VAS评分分别为(2.3±0.5)分、(1.1±0.3)分和(0.9±0.2)分,与对照组【分别为(2.5±0.6)分、(1.2±0.3)分和(1.0±0.3)分】比,差异均无统计学意义(P>0.05);观察组Ramsay镇痛评分分别为(2.4±0.5)分、(2.8±0.6)分和(3.1±0.7)分,均显著高于对照组【分别为(1.5±0.3)分、(1.9±0.4)分和(2.2±0.5)分,P<0.05】;观察组不良反应发生率为5.4%,显著低于对照组的21.6%(P<0.05)。结论在行LH治疗的PLC患者术后应用DEX复合BUT镇痛能够显著提高镇痛效果,可能有利于术后康复。Objective The aim of this study was to observe the post-operational analgesia effects of dexmedetomidine(DEX)and butorphanol(BUT)combination in patients with primary liver cancer(PLC)after laparoscopic hepatectomy(LH).Methods 74 patients with PLC were enrolled in our hospital between January 2019 and October 20222,and were randomly divided into control(n=37)and observation group(n=37).All patients underwent selective LH,and post-operationally,the patients in the control and in the observation group were intravenously pumping in sufentanil(SUF)and BUT,and Dex and BUT combination for analgesia.The pain and sedation after surgery were evaluated by visual analogue scale(VAS)and Ramsay sedation.Results The operation times and anesthesia times between the observation and the control group were(210.4±20.2)min and(228.7±30.6)min vs.(208.1±28.3)min and(226.5±32.9)min(P>0.05),while the recovery of spontaneous breathing and awakening time in the observation group were(15.5±3.1)min and(18.2±4.3)min,both significantly shorter than[(20.3±4.9)min and(22.9±4.9)min,P<0.05]in the control;at 4 h,24 h and 48 h post-operationally,the VAS scores in the observation group were(2.3±0.5),(1.1±0.3)and(0.9±0.2),not significantly different compared to[(2.5±0.6),(1.2±0.3)and(1.0±0.3),respectively,P>0.05]in the control;the Ramsay scores in the observation group were(2.4±0.5),(2.8±0.6)and(3.1±0.7),all significantly greater than[(1.5±0.3),(1.9±0.4)and(2.2±0.5),respectively,P<0.05]in the control;the incidence of untoward effects in the observation group was 5.4%,much lower than 21.6%(P<0.05)in the control.Conclusion The application of DEX and BUT combination after LH could obviously improve analgesia and relieve pain,which might improve the recovery of patients with PLC.

关 键 词：原发性肝癌 腹腔镜肝癌切除术 右美托咪定 布托啡诺 镇痛 

分 类 号：R614[医药卫生—麻醉学] R735.7[医药卫生—外科学]