| 不同剂量右美托咪定联合舒芬太尼对神经外科术后镇痛效果的比较 |
| 投稿时间：2018-01-25 修订日期：2018-03-06 点此下载全文 |
| 引用本文：孙西龙,王晶晶,刘万超,陈秀侠.不同剂量右美托咪定联合舒芬太尼对神经外科术后镇痛效果的比较[J].医学研究杂志,2018,47(11):141-145 |
| DOI：
10.11969/j.issn.1673-548X.2018.11.031 |
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| 中文摘要:目的 探讨不同剂量右美托咪定联合舒芬太尼用于神经外科术后静脉自控镇痛（PCIA）的效果及安全性，并探索其最佳剂量。方法 选择徐州医科大学附属医院择期全身麻醉下神经外科开颅肿瘤切除术患者120例，采用数表法随机分为4组，每组30例。PCIA配方：D0组：舒芬太尼2μg/kg+托烷司琼0.2mg/kg；D1组：右美托咪定1μg/kg+舒芬太尼2μg/kg+托烷司琼0.2mg/kg；D2组：右美托咪定1.5μg/kg+舒芬太尼2μg/kg+托烷司琼0.2mg/kg；D3组：右美托咪定2μg/kg+舒芬太尼2μg/kg+托烷司琼0.2mg/kg，每组均用0.9%NaCl溶液稀释至120ml。记录4组患者术后4、8、16、24、48h的VAS、Ramsay评分，各时段PCIA按压次数以及镇痛补救例数，并记录各组患者术后不良反应的发生率。结果 D2和D3组患者在术后各时间点VAS均较D0组低（P<0.05）；在8、16、24、48h，D2和D3组患者VAS较D1组低，差异有统计学意义（P<0.05）；D2组患者在术后8、16h时间点Ramsay评分较D0和D1组患者高（P<0.05）；D3组患者在4、8、16h时间点Ramsay评分较D0和D1组患者高，差异有统计学意义（P<0.05）；D1、D2 和D3组患者在术后各时段PCIA按压次数均低于D0组（P<0.05）；D2 和D3组患者在术后8、16、24h时段PCIA按压次数低于D1组，差异有统计学意义（P<0.05）；4组患者恶心、呕吐、烦躁、焦虑的发生率比较，差异无统计学意义，D3组2例患者出现心动过缓，2例患者嗜睡。4组均无过度镇静的发生。D2组总不良反应发生率较D0组低（P<0.05）。结论 1.5μg/kg右美托咪定联合2μg/kg舒芬太尼用于神经外科开颅肿瘤切除术术后镇痛，较单纯应用2μg/kg舒芬太尼而言，镇痛效果提高，总不良反应发生率低，未有心动过缓及嗜睡的发生。 |
| 中文关键词:神经外科手术 右美托咪定 术后镇痛 不良反应 |
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| Effect of Different Doses of Dexmedetomidine Combined with Sufentanil for Intravenous Controlled Analgesia after Neurosurgery |
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| Abstract:Objective To investigate the effect and safety of different doses of dexmedetomidine combined with sufentanil in patient-controlled intravenous analgesia (PCIA) after neurosurgery, and to determine the optimal dose. Methods A total of 120 patients underwent electrosurgical craniotomy were randomly divided into four groups according to random number table (RNT) in the Affiliated Hospital of Xuzhou Medical University. D0 group: 2μg/kg sufentanil + 0.2mg/kg tropisetron;D1 group:1.0μg/kg dexmedetomidine + 2μg/kg sufentanil + 0.2mg/kg tropisetron;D2 group:1.5μg/kg dexmedetomidine + 2μg/kg sufentanil + 0.2mg/kg tropisetron; D3 group:2μg/kg dexmedetomidine + 2μg/kg sufentanil + 0.2mg/kg tropisetron. Patients in each group were treated with 0.9% saline solution to 120ml.The VAS, Ramsay score, PCIA compression times and analgesic remedy were recorded at 4, 8, 16, 24 and 48 hours after operation.The incidence of postoperative adverse reactions was recorded. Results Patients in the D2 and D3 groups had lower VAS at each time point after surgery than in the D0 group. They also had lower VAS at 8h,16h,24h, 48h than in the D1 group (P<0.05). Patients in the D2 group had higher Ramsay scores at 8h,16h after surgery than in the D0 and D1 group; Patients in the D3 group had higher Ramsay scores at 4h,8h,16h than in the D0 and D1 group (P <0.05).The compression times of PCIA in patients with D1, D2 and D3 groups were lower than those in D0 group at each time postoperatively; D2 and D3 patients at the 8h, 16h, 24h PCIA compression times lower than the D1 group (P<0.05). There was no statistically significant difference in the incidence of nausea, vomiting, irritability and anxiety. There were 2 patients with bradycardia and 2 patients with sleepiness in the D3 group. There were no patients with excessive sedation.The total incidence of adverse events in the D2 group were less than that in the D0 group. Conclusion 1.5μg/kg dexmedetomidine combined with 2μg/kg sufentanil for neurosurgical craniotomy resection postoperative analgesia, compared with the simple application of 2μg/kg sufentanil, the analgesic effect is improved, and the total incidence of adverse reactions is low, without bradycardia and sleepiness. |
| keywords:Neurosurgery Dexmedetomidine Postoperative analgesia Adverse reaction |
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