摘要
目的观察右美托咪定联合舒芬太尼用于胸腔镜下食道癌根治术术后自控镇痛的效果。方法择期行胸腔镜下食道癌根治术患者54例,随机分为C组、DEX1和DEX2组,每组18例。C组:负荷剂量生理盐水+舒芬太尼PCA;DEX1组给负荷剂量DEX 0.5μg/kg+舒芬太尼PCA;DEX2组:给负荷剂量DEX0.5μg/kg+舒芬太尼复合DEX PCA。3组PCA给药方案:负荷量2 ml,维持2 ml/h,按压量2 ml,锁时15 min。采用Ramsay评分法对术后1和4 h患者进行镇静评分,采用VAS法对术后1、4、12和24 h静息和咳嗽时的疼痛进行评分;记录术后24 h舒芬太尼使用量、镇痛泵按压次数和给药次数,并计算按压次数/给药次数比值;记录发生呕心呕吐和呼吸抑制情况。结果 DEX1组在术后1 h、DEX2组在术后1和4 h镇静评分较C组显著性升高(P<0.05);DEX1组术后1 h静息和咳嗽时VAS评分、4 h静息时VAS评分和DEX2组术后不同时点静息和咳嗽时VAS评分均较C组显著性降低(P<0.05,P<0.01),但DEX2组在术后4 h咳嗽时疼痛、术后12、24 h静息咳嗽时VAS评分较DEX1组显著性降低(P<0.01);DEX2组较C组和DEX1组在术后24 h舒芬太尼使用量、术后4 h按压次数、给药次数和按压次数/给药次数比值均显著性降低(P<0.01);DEX2组患者满意度较DEX1组和C组显著性增高;而恶心呕吐发生率显著性降低(P<0.05)。结论舒芬太尼联合DEX为胸腔镜下食道癌患者提供PCA减少了舒芬太尼使用量,提高了镇痛效果,减少了恶心呕吐的发生,提高了患者的满意度。
[Objective] To evaluate the effect of dexmedetomidine combined with sufentanil on patientcontrolled analgesia （PCA） undergoing radical resection of esophagus cancer with thoracoseopes. [ Methods ] Fifty four patients scheduled for radical resection of esophagus cancer were randomly divided into three groups with eighteen patients in each group： group C： physiological saline bolus after medication and sufentanil PCA, Group DEXI： dexmedetomidine bolus （0.5 ug/ml） after medication and sufentanil PCA, Group DEX2： dexmedetomidine bolus （0.5 ug/kg） after medication and sufentanil with dexmedetomidine PCA. PCA administration schedule： Background infusion of 2 ml with 2 ml bolus, and with 15 rain lockout interval. Sedation level was measured at 1, 4 h after surgery by Ramsay method. Pain intensity at rest and cough were assessed by the VAS score at 1, 4, 12 and 24 h after surgery; Sulfentanyl comsumption, the numbers of pressing , pressing /administration ratio at 4 h after surgery were recorded, patients satisfactory was surveyed. Incidence of postoperative nausea and vomiting, respiratorydepression and hypotension were recorded. [Results] Sedation score in group DEX1 1 h after surgery , group DEX2 1, 4 h after surgery were significantly higher than those in group C （P 〈0.05）; VAS scores 1 h after surgery at rest and coughing, 4 h after surgery at rest in group DEX1, different times after surgery at rest and coughing in group DEX2 were significantly lower than those in group C （P 〈0.05, P 〈0.01）; Sulfentanyl comsumption 24 h after surgery, pressing, administration and pressing/administration ratio at 4 h after surgery and incidence of postoperative nausea and vomiting were significantly lower in group DEX2 than those in group C and group DXE1, while Patients satisfactory were significantly higher （P 〈0.05）. [ Conclusion ] The combination of sufentanil and dexmedetomidine for PCA after radical resection of esophagus cancer with thoracoscopes can reduce sufentanil consumption, decrease postoperative nausea and vomiting occurring and improve patient＇s satisfaction compared with sufentanil PCA alone.
出处
《中国内镜杂志》
北大核心
2015年第5期505-508,共4页
China Journal of Endoscopy
关键词
右美托咪定
VAS
食道癌根治术
自控镇痛
胸腔镜
dexmedetomidine
patient-controlled analgesia
VAS
radical resection of esophagus cancer
thoracoscopes
