| 氢吗啡酮复合右美托咪定在胸腔镜下肺叶切除术后镇痛的临床效果 |
| 投稿时间：2015-12-01 修订日期：2015-12-28 点此下载全文 |
| 引用本文：周俊辉,孟宪慧.氢吗啡酮复合右美托咪定在胸腔镜下肺叶切除术后镇痛的临床效果[J].医学研究杂志,2016,45(7):119-123 |
| DOI：
10.11969/j.issn.1673-548X.2016.07.032 |
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| 中文摘要:目的 评价氢吗啡酮复合右美托咪定在胸腔镜下肺叶切除术患者术后镇痛中的临床效果。方法 选取择期拟行胸腔镜下肺叶切除术的患者120例，采用随机数字表法分为3组，每组40例：A组患者术毕给予舒芬太尼2.0μg/kg进行术后镇痛；B组患者术毕给予舒芬太尼1.5μg/kg+氢吗啡酮0.15mg/kg进行术后镇痛；C组患者术毕给予舒芬太尼1.0μg/kg+氢吗啡酮0.15mg/kg+右美托咪定2.0μg/kg进行术后镇痛。3组术后镇痛泵总量为100ml，持续镇痛量2ml/h，单次负荷剂量2ml，锁定时间15min。分别于术前（T0）、术后2h（T1）、4h（T2）、8h（T3）、12h（T4）、24h（T5）及48h（T6）时记录3组患者心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）及呼吸频率（RR）；记录3组患者T1～T6时疼痛视觉模拟评分（VAS）及Ramsay镇静评分；记录3组患者术后48h内单次自控镇痛（PCA）平均按压次数及不良反应发生率。结果 B组和C组患者T1～T6时HR、MAP均较A组更平稳，组间比较差异有统计学意义（P<0.05）。B组和C组患者T1～T3时的VAS和Ramsay镇静评分均低于A组（P<0.05），且C组患者T1～T3时的VAS和Ramsay镇静评分均低于B组（P<0.05）。B组和C组患者术后48h内的PCA平均按压次数低于A组，而C组患者术后48h内的PCA平均按压次数低于B组（P<0.05）。B组和C组患者的总不良反应发生率显著低于A组（P<0.05）。结论 氢吗啡酮复合右美托咪定应用于胸腔镜下肺叶切除术患者的术后镇痛效果较好，可减少舒芬太尼的用量，且不良反应较少，安全性较高。 |
| 中文关键词:氢吗啡酮|右美托咪定|术后镇痛|肺叶切除术|视频辅助胸腔镜 |
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| Clinical Efficacy of Hydromorphone Combined with Dexmedetomidine in Postoperative Analgesia of Video-assisted-thoracoscopic Lobectomy |
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| Abstract:Objective To explore the clinical efficacy of hydromorphone combined with dexmedetomidine in postoperative analgesia of video-assisted-thoracoscopic lobectomy. Methods Totally 120 patients undergoing video-assisted-thoracoscopic lobectomy were randomly divided into three groups (n=40 each) as follows:group A (administration of 2.0μg/kg of sufentanil), group B (administration of 1.5μg/kg of sufentanil and 0.15mg/kg of hydromorphone) and group C (administration of 1.0μg/kg of sufentanil, 0.15mg/kg of hydromorphone and 2.0μg/kg of dexmedetomidine). All the postoperative analgesia pumps were adjusted in a standard of 100 ml volume, continuous perfusion rate 2ml/h, single bolus 2ml and lockout time 15min. Heart rate (HR), mean artery blood pressure (MAP), oxygen saturation (SpO2), respiratory rate (RR) of the patients were recorded at different time-points before operations (T0) and 2h (T1), 4h (T2), 8h (T3), 12h (T4), 24h (T5), 48h (T6) after operations. Pain levels (VAS assessment) and sedation scores (Ramsay assessment) of the patients were recorded from T1 to T6. The average press number of patient-controlled analgesia (PCA) and adverse reactions within 48 h after operation were analyzed. Results MAP and HR in group B and C were more stable than those in group A, and there was statistically significant differences (all P<0.05) in MAP and HR among these three groups. VAS and Ramsay sedation scores of group B and C were lower (both P<0.05) than those of group A from T1 to T3 after surgery, and VAS and Ramsay sedation scores of group C were lower (both P<0.05) than those of group B from T1 to T3 after surgery. The average press numbers of PCA of group B and C were lower significantly than that of group A at 48 h after operation, the average press number of PCA of group C was lower significantly than that of group B, and there was statistically significant differences (all P<0.05) in the average press numbers of PCA among these three groups. The incidence rate of total adverse reactions of group B and C were lower than that of group A (P<0.05). Conclusion The postoperative analgesia effect of hydromorphone combined with dexmedetomidine after video-assisted-thoracoscopic lobectomy is favourable, and the combination can reduce the dose of sufentanil, with less adverse reaction and higher security. |
| keywords:Hydromorphone|Dexmedetomidine|Postoperative analgesia|Lobectomy|Video-assisted-thoracoscopic |
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