右美托咪定复合舒芬太尼自控静脉镇痛对阴式子宫切除术患者术后应激指标及疼痛状态的影响  

Influence of patient-controlled intravenous analgesia with dexmedetomidine combined with sufentanil on postop⁃erative stress indicators and pain status in patients with vaginal hysterectomy

作　　者：叶玉萍 陶振云 刘双庆 季敏鹏 YE Yuping;TAO Zhenyun;LIU Sh-uangqing(Department of Anesthesiology,Affiliated Stomatological Hospital of Nanchang Univeristy,Nanchang 330006,China)

机构地区：[1]南昌大学附属口腔医院麻醉科,江西南昌330006 [2]义乌市中心医院麻醉科

出　　处：《全科医学临床与教育》2024年第7期611-615,共5页Clinical Education of General Practice

基　　金：2022年度金华市公益性技术应用研究项目(2022-4-333)。

摘　　要：目的分析右美托咪定复合舒芬太尼自控静脉镇痛对阴式子宫切除术患者术后应激及疼痛状态的影响。方法选择102例阴式子宫切除术患者为研究对象,随机分为联合组(给予右美托咪定复合舒芬太尼自控镇痛)和对照组(给予舒芬太尼自控镇痛)各51例。比较两组术毕(T_(0))、术后2 h(T_(1))、术后6 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))的血流动力学指标[心率(HR)、氧饱和度(SpO2)、平均动脉压(MAP)]、自控静脉镇痛(PCIA)次数、应激反应指标[促肾上腺皮质激素(ACTH)、皮质醇(Cor)、醛固酮(ALD)、白介素-6(IL-6)],T_(0)、T_(4)时段的疼痛因子[β内啡肽(β-EP)、血清P物质(SP)、神经肽Y(NPY)]水平、视觉模拟评分(VAS)以及不良反应。结果T_(2)时,联合组HR和MAP低于对照组(t分别=2.27、6.05,P均<0.05),T_(3)、T_(4)时,联合组HR高于对照组,MAP低于对照组(t分别=-2.22、-4.90;2.78、2.55,P均<0.05);T_(2)~T_(4)时,SpO2水平高于对照组(t分别=-18.06、-6.93、-6.29,P<0.05);联合组PCIA总次数少于对照组(t=2.27,P<0.05);T_(1)~T_(4)时,联合组ACTH、Cor、ALD水平均低于对照组(t分别=21.75、38.55、41.42;41.91、2.12、2.60、5.80;5.75,4.26、5.91、7.51、20.01,P均<0.05),T_(3)、T_(4)时,联合组IL-6水平低于对照组(t分别=4.68、13.20,P均<0.05);T_(4)时,联合组β-EP、SP和NPY水平均低于对照组(t分别=10.91、12.53、12.34,P均<0.05);T_(1)~T_(4)时,联合组VAS评分均低于对照组(t分别=2.82、4.59、13.77、11.01,P均<0.05);联合组术后不良反应总发生率与对照组比较,差异无统计学意义(χ^(2)=0.64,P>0.05)。结论右美托咪定复合舒芬太尼自控静脉镇痛有利于改善阴式子宫切除术患者术后应激指标和稳定血流动力学指标,迅速有效地缓解疼痛,且不良反应发生风险较低。Objective To analyze the influence of dexmetomidine combined with sufentanil for patient-controlled intra-venous analgesia on postoperative stress and pain status in patients with vaginal hysterectomy.Methods A total of 102 patients with vaginal hysterectomy were selected as the study subjects and randomly divided into combined group(dex-medetomidine combined with sufentanil patient-controlled analgesia,51 cases)and control group(sufentanil patient-con-trolled analgesia,51 cases).The hemodynamic indicators[heart rate(HR),oxygen saturation(SpO2),mean arterial pres-sure(MAP)],patient-controlled intravenous analgesia(PCIA)frequency and stress response indicators[adrenocortico-tropic hormone(ACTH),cortisol(Cor),aldosterone(ALD),interleukin-6(IL-6)]after the end of surgery(T_(0)),2 hours(T_(1)),6 hours(T_(2)),12 hours(T_(3))and 24 hours after surgery(T_(4)),levels of pain factors[βendorphin(β-EP),serum substance P(SP),neuropeptide Y(NPY)],visual analogue score(VAS)and adverse reactions at T_(0) and T_(4) were compared between the two groups.Re-sults At T_(2),the HR and MAP in combined group were lower than those in control group(t=2.27,6.05,P<0.05),and HR at T_(3) and T_(4) were higher than those in control group,MAP were lower than those in the control group(t=-2.22,-4.90,2.78,2.55,P<0.05).The SpO2 in combined group was higher than that in control group at T_(2),T_(3),T_(4)(t=-18.06,-6.93,-6.29,P<0.05).The total PCIA frequency in combined group was less than that in control group(t=2.27,P<0.05).The levels of ACTH,Cor and ALD at T_(1),T_(2),T_(3),T_(4) were lower in combined group than those in control group(t=21.75,38.55,41.42,41.91,2.12,2.60,5.80,5.75,4.26,5.91,7.51,20.01,P<0.05),and the level of IL-6 in combined group at T_(3) and T_(4) was lower than that in control group(t=4.68,13.20,P<0.05).The levels ofβ-EP,SP and NPY in combined group were lower than those in control group at T_(4)(t=10.91,12.53,12.34,P<0.05).The VAS score in combined group was lower compared with that in control group at T_(1),T_(2),T_(3),

关 键 词：右美托咪定 舒芬太尼 自控静脉镇痛 阴式子宫切除术 术后应激 疼痛 

分 类 号：R614[医药卫生—麻醉学]