中国医科大学学报

中国医科大学学报
  • 中文核心期刊
  • 中国科技核心期刊
  • 中国高校百佳科技期刊
  • BA、CA收录

中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (4): 346-349,354.doi: 10.12007/j.issn.0258-4646.2018.04.013

• 论著 • 上一篇    下一篇

右美托咪定复合舒芬太尼或布托啡诺用于腹腔镜胃肠道手术术后镇痛的效果

孔雪, 王俊   

  1. 中国医科大学附属第一医院麻醉科, 沈阳 110001
  • 收稿日期:2017-07-11 出版日期:2018-04-30 发布日期:2018-04-10
  • 通讯作者: 王俊 E-mail:wangjuncmu@126.com
  • 作者简介:孔雪(1984-),女,医师,硕士.

Effects of Dexmedetomidine Combined with Sufentanil or Butorphanol for Postoperative Analgesia after Laparoscopic Gastrointestinal Surgery

KONG Xue, WANG Jun   

  1. Department of Anesthesiology, The First Hospital, China Medical University, Shenyang 110001, China
  • Received:2017-07-11 Online:2018-04-30 Published:2018-04-10

摘要: 目的 观察右美托咪定复合舒芬太尼或布托啡诺用于腹腔镜胃肠道手术患者自控静脉镇痛(PCIA)的效果。方法 选择美国麻醉医师协会(ASA)Ⅰ~Ⅱ级,择期行腹腔镜胃肠道手术的患者80例,术后予PCIA镇痛。将患者随机分为4组:舒芬太尼(S组),右美托咪定+舒芬太尼(DS组),布托啡诺(B组)和右美托咪定+布托啡诺(DB组),PCIA容量及参数设置相同。记录4组术后0 h(T0)、4 h(T1)、8 h(T2)、12 h(T3)、24 h(T4)及48 h(T5)各时点患者静息和活动疼痛视觉模拟(VAS)评分、Ramsay镇静评分和舒适度(BCS)评分,各组不良反应情况等。结果 与S组及B组相比,DS与DB组T0~T2静息VAS评分,T0~T4活动VAS评分降低(P < 0.05);DS组T0~T1以及DB组T0~T3的Ramsay评分增高(P < 0.05);DS与DB组T0~T1的BCS评分增高(P < 0.05);DB组头晕及嗜睡发生率增高(P < 0.05);4组均无明显呼吸抑制。结论 右美托咪定复合舒芬太尼或布托啡诺用于PCIA镇痛安全有效,较单独应用舒芬太尼或布托啡诺镇痛满意度及舒适度更高,右美托咪定复合舒芬太尼满意镇痛的同时嗜睡发生更少。

关键词: 右美托咪定, 舒芬太尼, 布托啡诺

Abstract: Objective To observe the efficacy of dexmedetomidine in combination with sufentanil or butorphanol for postoperative patient-controlled intravenous analgesia (PCIA) after laparoscopic gastrointestinal surgery. Methods Eighty patients (ASAⅠ or Ⅱ) who were scheduled to undergo elective laparoscopic gastrointestinal surgery were offered PCIA for pain management. They were randomly divided into four groups,namely,sufentanil (group S);dexmedetomidine+sufentanil (group DS),butorphanol (group B);and dexmedetomidine+butorphanol (group DB). The four groups received the same volume and had the same pump setting pattern. The rest and activity visual analogue scores (VAS),Ramsay score and comfort score (BCS) were recorded at hour 0 (T0),4 (T1),8 (T2),12 (T3),24 (T4),and 48 (T5). The side-effects were also examined. Results Compared with group S and group B,the rest VAS score at T0-T2 and activity VAS score at T0-T4 in group DS and group DB decreased (P < 0.05). Ramsay scores of the group DS at T0-T1 and group DB at T0-T3 increased (P < 0.05);additionally,the BCS scores were higher at T0-T1 in these two groups (P < 0.05). The incidence of dizziness and drowsiness in group DB increased (P < 0.05). There were no reports of respiratory depression in all patients. Conclusion Dexmedetomidine plus sufentanil or butorphanol can be used safely and effectively for PCIA,and their application can provide better analgesia satisfaction and comfort than sufentanil or butorphanol separately. The combination of dexmedetomidine and sufentanil was associated with a low incidence of somnolence.

Key words: dexmedetomidine, sufentanil, butorphanol

中图分类号: 

  • R614.2
[1] 徐建国,吴新民,罗爱伦,等.成人术后疼痛处理专家共识[J].临床麻醉学杂志,2010(3):190-196.
[2] 黄宇光,黄文起,李刚,等.酒石酸布托啡诺镇痛专家共识[J].临床麻醉学杂志,2011,27(10):1028-1029.
[3] BHARTI N,CHARI P. Epidural butorphanol-bupivacaine analgesia for postoperative pain relief after abdominal hysterectomy[J]. J Clin Anesth,2009,21(1):19-22. DOI:10.1016/j.jclinane.2008.06.023.
[4] REN C,CHI M,ZHANG Y,et al.Dexmedetomidine in postoperative analgesia in patients undergoing hysterectomy:a CONSORT-prospective randomized controlled trial[J]. Medicine (Baltimore),2015,94(32):e1348. DOI:10.1097/MD.0000000000001348.
[5] NICHOLSON A,LOWE MC,PARKER J,et al. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients[J]. Br J Surg,2014,101(3):172-188. DOI:10.1002/bjs.9394.
[6] APFELBAUM JL,CHEN C,METHA SS,et al.Postoperative pain experience:results from a national survey suggest postoperative pain continues to be undermanaged[J]. Anesth Analg,2003,97(2):534-540.
[7] LARSON DW,LOVELY JK,CIMA RR,et al. Outcomes after implementanion of a multimodal standard care pathway for laparoscopic colorectal surgery[J]. Br J Surg,2014,101(8):1023-1030. DOI:10.1002/bjs.9534.
[8] RAWAL N.Current issues in postoperative pain management[J]. Eur J Anaesthesiol,2016,33(3):160-171. DOI:10.1097/EJA.0000000000000366.
[9] ELIA N,LYSAKOWSKI C,TRAMER MR. Does multimodal analgesia with acetaminophen,nonsteroidal antiinflammatory drugs,or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone?Meta-analyses of randomized trials[J]. Anesthesiology,2005,103(6):1296-1304.
[10] 钱卫,刘燕,杜学柯,等. 布托啡诺用于术后病人自控静脉镇痛(PCIA)的Meta分析[J]. 中国疼痛医学杂志,2011,17(2):97-101. DOI:10.3969/j.issn.1006-9582.2011.02.005.
[11] TALKE P,CHEN R,THOMAS B,et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery[J]. Anesth Analg,2000,90(4):834-849.
[1] 肖甄男, 商丽华, 龙波. 超声引导腹横肌平面阻滞复合右美托咪定在老年患者腹股沟疝修补术术中及术后的镇痛效果[J]. 中国医科大学学报, 2018, 47(6): 507-512.
[2] 冯静,吴秀英. 不同自控镇痛模式用于腹腔镜下子宫肌瘤剔除术的临床效果观察[J]. 中国医科大学学报, 2017, 46(9): 839-843.
[3] 李阳,李秀艳,曹悦悦,王宏玉,麻婷婷,朱俊超. 不同剂量舒芬太尼在全麻诱导气管插管时对定量药物脑电图α1 频段的影响[J]. 中国医科大学学报, 2017, 46(5): 409-412.
[4] 李欣明,李松泽,刘洪涛. 右美托咪定对谷氨酸诱导的大鼠神经系统毒性作用的影响[J]. 中国医科大学学报, 2017, 46(4): 302-305.
[5] 孙越,邱爽,董有静. 右美托咪定对应用止血带行下肢手术的患者心率变异性的影响[J]. 中国医科大学学报, 2017, 46(2): 107-111.
[6] 肖甄男,龙波,于砾淳,白茹冰. 右美托咪定对肥胖患者苏醒期的影响[J]. 中国医科大学学报, 2017, 46(10): 913-916.
[7] 乔海峰,陈宏志. 右美托咪定预防七氟醚麻醉下麦粒肿手术小儿苏醒期躁动的研究[J]. 中国医科大学学报, 2016, 45(9): 843-847.
[8] 张焕焕,李阳,滕秀飞,杨延超,万玉骁,万静洁,朱俊超. 右美托咪定复合舒芬太尼用于妇科腹腔镜手术患者术后镇痛的 效果观察[J]. 中国医科大学学报, 2016, 45(4): 333-336.
[9] 朱俊超,滕秀飞,杨延超,万玉骁,李阳. 经皮穴位电刺激与右美托咪定对腹腔镜手术患者术后早期 认知功能的影响[J]. 中国医科大学学报, 2016, 45(4): 345-348.
[10] 张鑫,吴秀英. 不同剂量右美托咪定对焦虑患者情绪及记忆影响的比较[J]. 中国医科大学学报, 2016, 45(3): 218-221.
[11] 李阳,万玉骁,杨延超,滕秀飞,李真,朱俊超. 右美托咪定联合美维松在小儿扁桃体摘除手术中的应用[J]. 中国医科大学学报, 2016, 45(3): 260-263.
[12] 杨悦,马铃,代玉婷,马扬,孙雪晨,姜美玲. 盐酸右美托咪定对开腹结直肠癌根治术患者围术期肺动态 顺应性和外周血中 TLR-2 和 TLR-4 表达的影响[J]. 中国医科大学学报, 2016, 45(12): 1077-1081.
[13] 侯大亮,吴秀英. 右美托咪定对开腹手术中老年患者脑氧饱和度及 术后认知功能的影响[J]. 中国医科大学学报, 2016, 45(11): 1039-1042.
[14] 周泓旭,虞建刚,方波,马虹. 右美托咪定用于非体外循环冠状动脉移植术患者的临床观察[J]. 中国医科大学学报, 2015, 44(4): 332-337.
[15] 赵晓春,佟冬怡,龙波,池晓颖,张立民,吴秀英. 右美托咪定对腹腔镜手术七氟醚用药量的影响[J]. 中国医科大学学报, 2014, 43(2): 110-113.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!

中国医科大学学报版权所有©2018

未经允许,严禁擅自转载本站图文资料

地址:中国 沈阳市沈北新区蒲河路77号 110122

辽ICP备05014850

JOURNAL OF CHINA MEDICAL UNIVERSITY

ADDRESS: NO.77 PUHE ROAD

SHENYANG NORTH NEW AREA, SHENYANG

LIAONING PROVINCE, P.R. CHINA