右美托咪定聯(lián)合芬太尼在胸腔鏡下肺葉切除術(shù)術(shù)后自控靜脈鎮(zhèn)痛中的應(yīng)用

丁壬嫻+單希勝

【摘要】 目的 探索右美托咪定（DEX）與芬太尼聯(lián)合應(yīng)用于胸腔鏡下肺葉切除術(shù)術(shù)后自控靜脈鎮(zhèn)痛的效果。方法 70例行胸腔鏡肺葉切除術(shù)患者， 根據(jù)術(shù)后靜脈鎮(zhèn)痛泵中應(yīng)用藥物不同分為DEX組和對(duì)照組， 每組35例。DEX組術(shù)后鎮(zhèn)痛應(yīng)用芬太尼和DEX；對(duì)照組術(shù)后鎮(zhèn)痛使用芬太尼。記錄術(shù)后24 h各個(gè)時(shí)間段（術(shù)后2、4、8、12、24 h）鎮(zhèn)痛藥物使用總量、視覺模擬評(píng)分法（VAS）評(píng)分及經(jīng)靜脈患者自控鎮(zhèn)痛（PCIA）相關(guān)并發(fā)癥。結(jié)果 DEX組患者在術(shù)后24 h內(nèi)各時(shí)間段芬太尼消耗量明顯少于對(duì)照組， 差異有統(tǒng)計(jì)學(xué)意義（P<0.05）， 術(shù)后24 h芬太尼消耗量， DEX組比對(duì)照組減少15%。兩組患者在術(shù)后24 h內(nèi)各時(shí)間點(diǎn)VAS評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。DEX組術(shù)后發(fā)生惡心、嘔吐發(fā)生率與對(duì)照組比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；DEX組不良反應(yīng)總發(fā)生率（8.6%）低于對(duì)照組（28.6%）， 差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 DEX輔助芬太尼術(shù)后鎮(zhèn)痛， 臨床反應(yīng)好， 不良反應(yīng)少， 可以提高術(shù)后鎮(zhèn)痛舒適度， 值得臨床推廣。

【關(guān)鍵詞】 右美托咪定；術(shù)后鎮(zhèn)痛；肺葉切除術(shù)；經(jīng)靜脈患者自控鎮(zhèn)痛

DOI：10.14163/j.cnki.11-5547/r.2017.29.054

【Abstract】 Objective To investigate the effect of dexmedetomidine （DEX） combined with fentanyl in postoperative patient-controlled intravenous analgesia after thoracoscopic lobectomy. Methods A total of 70 patients undergoing thoracoscopic lobectomy were divided by different drugs in postoperative patient-controlled intravenous analgesia into DEX group and control group， with 35 cases in each group. DEX group received fentanyl and DEX for postoperative analgesia， and the control group received fentanyl for postoperative analgesia. Record were made on total dose of analgesic drugs， visual analogue scale （VAS） score， and patient-controlled intravenous analgesia （PCIA） related complications were measured at all time points of postoperative 24 h （postoperative 2， 4， 8， 12）. Results DEX group had obviously less fentanyl consumption at all time points of postoperative 24 h than the control group， and the difference was statistically significant （P<0.05）. Fentanyl consumption in postoperative 24 h was 15% lower in the DEX group than in the control group. Both groups had no statistically significant difference in VAS score at all time points of postoperative 24 h （P>0.05）. DEX group had no statistically significant difference in incidence of postoperative nausea and vomiting， comparing with the control group （P>0.05）. DEX group had lower incidence of total adverse reactions （8.6%） than the control group （28.6%）， and the difference was statistically significant （P<0.05）. Conclusion DEX assisted fentanyl postoperative analgesia shows good clinical response and less adverse reactions， and it can improve postoperative analgesic comfort. It is worthy of clinical promotion.

【Key words】 Dexmedetomidine； Postoperative analgesia； Lobectomy； Patient-controlled intravenous analgesia

良好的術(shù)后鎮(zhèn)痛可以減少患者應(yīng)激反應(yīng)， 改善患者舒適程度， 促進(jìn)早期胃腸功能恢復(fù)， 目前多提倡多模式鎮(zhèn)痛觀

念[1-3]。術(shù)后PCIA是最常見的選擇方法。近年來(lái)， 術(shù)后泵入DEX成為術(shù)后鎮(zhèn)痛的熱點(diǎn)， 本研究是評(píng)估行胸腔鏡下肺葉切除術(shù)術(shù)后PCIA中使用DEX作為術(shù)后鎮(zhèn)痛的安全性和有效性， 為臨床提供參考。報(bào)告如下。endprint

1 資料與方法

1. 1 一般資料 選擇2016年1月～2017年6月70例擇期行胸腔鏡下肺葉切除術(shù)患者， 年齡18～70歲， 美國(guó)麻醉醫(yī)師協(xié)會(huì)（ASA）Ⅰ～Ⅱ級(jí)。排除標(biāo)準(zhǔn)：術(shù)前緩慢型心律失常、肝腎功能異常、冠心病、有暈動(dòng)病史者。本研究經(jīng)蘇州大學(xué)附屬第一醫(yī)院倫理委員會(huì)批準(zhǔn)， 所有患者自愿簽署知情同意書。根據(jù)術(shù)后靜脈鎮(zhèn)痛泵中應(yīng)用藥物不同分為DEX組和對(duì)照組， 各35例。兩組……