中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
3期
274-277
,共4页
右美托咪啶%舒芬太尼%镇痛,病人控制%剖宫产术%疼痛,手术后
右美託咪啶%舒芬太尼%鎮痛,病人控製%剖宮產術%疼痛,手術後
우미탁미정%서분태니%진통,병인공제%부궁산술%동통,수술후
Dexmedetomidine%Sufentanil%Analgesia,patient-controlled%Caesarean section%Pain postoperative
目的 评价右美托咪啶混合舒芬太尼用于剖宫产术后病人自控静脉镇痛(PCIA)的效果.方法 择期脊椎-硬膜外麻醉下行剖宫产术病人120例,年龄18～40岁,身高155～170 cm,采用随机数字表法,将病人随机分为3组(n=40):Ⅰ组于胎儿娩出后静脉注射生理盐水20 ml,术后采用舒芬太尼进行PCIA(背景输注速率0.015μg·kg-1·h-1,PCA量0.023 μg/kg,锁定时间8 min);Ⅱ组于胎儿娩出后静脉注射右美托咪啶0.5 μg/kg,术后PCIA同Ⅰ组;Ⅲ组术中处理同Ⅱ组,术后采用舒芬太尼混合右美托咪啶进行PCIA(舒芬太尼背景输注速率0.015 μg·kg-1·h-1,右美托咪啶背景输注速率0.045 μg·kg-1·h-1,舒芬太尼PCA量0.023 μg/kg、右美托咪啶PCA量0.07 μg/kg,锁定时间8 min).于麻醉前和输注右美托咪啶1 h时测定痛阈和耐痛阈,于术后4、8、24 h时记录VAS评分、警觉/镇静评分和舒芬太尼用量,于术后3 h时记录恶露排出量,记录泌乳发动时间,于术后24 h时行病人满意度评价,于麻醉前和输注右美托咪啶1 h、术后24 h时采集外周静脉血样,采用双抗体夹心酶联免疫吸附法测定血清皮质醇浓度,记录不良反应的发生情况.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组输注右美托眯啶1 h时痛阈和耐痛阈升高,Ⅲ组术后4、8、24 h时VAS评分和舒芬太尼用量降低,病人满意度升高(P＜0.05);与Ⅱ组比较,Ⅲ组术后4、8、24 h时VAS评分和舒芬太尼用量降低,Ⅲ组病人满意度升高(P＜0.05);其余指标组间比较差异无统计学意义(P＞0.05).结论 右美托咪啶混合舒芬太尼用于剖宫产术后PCIA的效果优于单独应用舒芬太尼.
目的 評價右美託咪啶混閤舒芬太尼用于剖宮產術後病人自控靜脈鎮痛(PCIA)的效果.方法 擇期脊椎-硬膜外痳醉下行剖宮產術病人120例,年齡18～40歲,身高155～170 cm,採用隨機數字錶法,將病人隨機分為3組(n=40):Ⅰ組于胎兒娩齣後靜脈註射生理鹽水20 ml,術後採用舒芬太尼進行PCIA(揹景輸註速率0.015μg·kg-1·h-1,PCA量0.023 μg/kg,鎖定時間8 min);Ⅱ組于胎兒娩齣後靜脈註射右美託咪啶0.5 μg/kg,術後PCIA同Ⅰ組;Ⅲ組術中處理同Ⅱ組,術後採用舒芬太尼混閤右美託咪啶進行PCIA(舒芬太尼揹景輸註速率0.015 μg·kg-1·h-1,右美託咪啶揹景輸註速率0.045 μg·kg-1·h-1,舒芬太尼PCA量0.023 μg/kg、右美託咪啶PCA量0.07 μg/kg,鎖定時間8 min).于痳醉前和輸註右美託咪啶1 h時測定痛閾和耐痛閾,于術後4、8、24 h時記錄VAS評分、警覺/鎮靜評分和舒芬太尼用量,于術後3 h時記錄噁露排齣量,記錄泌乳髮動時間,于術後24 h時行病人滿意度評價,于痳醉前和輸註右美託咪啶1 h、術後24 h時採集外週靜脈血樣,採用雙抗體夾心酶聯免疫吸附法測定血清皮質醇濃度,記錄不良反應的髮生情況.結果 與Ⅰ組比較,Ⅱ組和Ⅲ組輸註右美託瞇啶1 h時痛閾和耐痛閾升高,Ⅲ組術後4、8、24 h時VAS評分和舒芬太尼用量降低,病人滿意度升高(P＜0.05);與Ⅱ組比較,Ⅲ組術後4、8、24 h時VAS評分和舒芬太尼用量降低,Ⅲ組病人滿意度升高(P＜0.05);其餘指標組間比較差異無統計學意義(P＞0.05).結論 右美託咪啶混閤舒芬太尼用于剖宮產術後PCIA的效果優于單獨應用舒芬太尼.
목적 평개우미탁미정혼합서분태니용우부궁산술후병인자공정맥진통(PCIA)적효과.방법 택기척추-경막외마취하행부궁산술병인120례,년령18～40세,신고155～170 cm,채용수궤수자표법,장병인수궤분위3조(n=40):Ⅰ조우태인면출후정맥주사생리염수20 ml,술후채용서분태니진행PCIA(배경수주속솔0.015μg·kg-1·h-1,PCA량0.023 μg/kg,쇄정시간8 min);Ⅱ조우태인면출후정맥주사우미탁미정0.5 μg/kg,술후PCIA동Ⅰ조;Ⅲ조술중처리동Ⅱ조,술후채용서분태니혼합우미탁미정진행PCIA(서분태니배경수주속솔0.015 μg·kg-1·h-1,우미탁미정배경수주속솔0.045 μg·kg-1·h-1,서분태니PCA량0.023 μg/kg、우미탁미정PCA량0.07 μg/kg,쇄정시간8 min).우마취전화수주우미탁미정1 h시측정통역화내통역,우술후4、8、24 h시기록VAS평분、경각/진정평분화서분태니용량,우술후3 h시기록악로배출량,기록비유발동시간,우술후24 h시행병인만의도평개,우마취전화수주우미탁미정1 h、술후24 h시채집외주정맥혈양,채용쌍항체협심매련면역흡부법측정혈청피질순농도,기록불량반응적발생정황.결과 여Ⅰ조비교,Ⅱ조화Ⅲ조수주우미탁미정1 h시통역화내통역승고,Ⅲ조술후4、8、24 h시VAS평분화서분태니용량강저,병인만의도승고(P＜0.05);여Ⅱ조비교,Ⅲ조술후4、8、24 h시VAS평분화서분태니용량강저,Ⅲ조병인만의도승고(P＜0.05);기여지표조간비교차이무통계학의의(P＞0.05).결론 우미탁미정혼합서분태니용우부궁산술후PCIA적효과우우단독응용서분태니.
Objective To evaluate the efficacy of dexmedetomidine combined with sufentanil for patientcontrolled intravenous analgesia (PCIA) after caeserean section. Methods One hundred and twenty parturients aged 18-40 yr undergoing caeserean section under spinal-epidural anesthesia were randomly assigned to one of 3 groups( n=40 each):group Ⅰ , group Ⅱ and group Ⅲ . During operation as soon as the baby was bom a bolus of dexmedetomidine 0.5 μg/kg was given iv in Ⅱ and Ⅲ groups while in group Ⅰ normal saline (NS) was given instead. Ⅰ and Ⅱ groups received PCIA with sufentanil (background infusion 0.015 μg·kg-1·h-1;bolus dose 0.023 μg/kg;lockout interval 8 min). Group Ⅲ received PCIA with sufentanil + dexmedetomidine (background infusion sufentanil 0.015 μg·kg-1 ·h-1 + dexmedetomidine 0.045 μg·kg· h-1;bolus dose sufentanil 0.023 μg/kg + dexmedetomidine 0.07 μg/kg;lockout interval 8 min) . Pain threshold and pain tolerance threshold were measured before caeserean section and 1 h after bolus dose of dexmedetomidine or NS. VAS, OAA/S and satisfaction scores and sufentanil consumption were recorded at 4, 8 and 24 h after operation.Blood samples were obtained before anesthesia,1 h after bolus injection of dexmedetomidine, and 24 h after operation for determination of serumcortisol concentration. Results Pain threshold and pain tolerance threshold at 1 h after bolus injection of dexmedetomidine were significantly increased as compared with the baseline before anesthesia in Ⅱ and Ⅲ groups and were significantly higher in Ⅱ and Ⅲ groups than in group Ⅰ . VAS scores and the consumption of sufentanil were significantly lower while the satisfactory score was significantly higher in group Ⅲ than in Ⅰ and Ⅱ groups. Serum cortisol concentrations were significantly increased at 1 h after iv dexmedetomidine or NS injection as compared with the baseline before anesthesia in all 3 groups, but there was no significant difference in serum cortisol levels among the 3 groups. Conclusion Addition of dexmedetomidine to sufentanil for PCIA can significantly reduce the consumption of sufentanil and improve parturient's satisfaction.
