蚌埠医学院学报
蚌埠醫學院學報
방부의학원학보
ACTA ACADEMIAE MEDICINAE BENGBU
2014年
11期
1500-1502
,共3页
镇痛%右美托咪啶%芬太尼%开胸手术
鎮痛%右美託咪啶%芬太尼%開胸手術
진통%우미탁미정%분태니%개흉수술
analgesia%dexmedetomidine%fentanil%thoracic surgery
目的：探讨右美托咪啶对开胸手术患者术后芬太尼自控静脉镇痛效果的影响。方法：ASAⅠ~Ⅲ级择期行开胸手术患者40例,随机分成2组,术后均行静脉自控镇痛( PCIA),镇痛药配方为芬太尼20μg/kg( C组),芬太尼20μg/kg+右美托咪啶10μg/kg(D组),用0.9%氯化钠注射液稀释至100 ml。初始负荷剂量2 ml,持续剂量2 ml/h,单次静脉快注(Bolus)剂量0.5 ml,锁定时间15 min。记录各组患者术后24 h内Bolus总按压次数及芬太尼用量,术后4、8、24、48 h的镇痛视觉模拟评分和Ramsay镇静评分,术后各组患者呼吸抑制、恶心呕吐、心率<50次/分,收缩压<90 mmHg等不良反应的发生情况,于麻醉前、术后4、8、24 h测定血清皮质醇浓度；于术后48 h评价患者满意度。结果：与C组比较,D组术后24 h内Bolus总按压次数减少,芬太尼用量降低(P<0.01)；D组各时点Ramsay镇静评分均较C组明显升高(P<0.01),D组术后4 h和8 h的镇痛视觉模拟评分均较C组降低(P<0.01和P<0.05)；2组患者呼吸抑制、恶心呕吐发生率及术后4~48 h皮质醇水平差异均无统计学意义(P>0.05),D组患者满意度高于C组(P<0.05)。结论：右美托咪啶复合芬太尼用于开胸手术后PCIA的效果优于单独应用芬太尼。
目的：探討右美託咪啶對開胸手術患者術後芬太尼自控靜脈鎮痛效果的影響。方法：ASAⅠ~Ⅲ級擇期行開胸手術患者40例,隨機分成2組,術後均行靜脈自控鎮痛( PCIA),鎮痛藥配方為芬太尼20μg/kg( C組),芬太尼20μg/kg+右美託咪啶10μg/kg(D組),用0.9%氯化鈉註射液稀釋至100 ml。初始負荷劑量2 ml,持續劑量2 ml/h,單次靜脈快註(Bolus)劑量0.5 ml,鎖定時間15 min。記錄各組患者術後24 h內Bolus總按壓次數及芬太尼用量,術後4、8、24、48 h的鎮痛視覺模擬評分和Ramsay鎮靜評分,術後各組患者呼吸抑製、噁心嘔吐、心率<50次/分,收縮壓<90 mmHg等不良反應的髮生情況,于痳醉前、術後4、8、24 h測定血清皮質醇濃度；于術後48 h評價患者滿意度。結果：與C組比較,D組術後24 h內Bolus總按壓次數減少,芬太尼用量降低(P<0.01)；D組各時點Ramsay鎮靜評分均較C組明顯升高(P<0.01),D組術後4 h和8 h的鎮痛視覺模擬評分均較C組降低(P<0.01和P<0.05)；2組患者呼吸抑製、噁心嘔吐髮生率及術後4~48 h皮質醇水平差異均無統計學意義(P>0.05),D組患者滿意度高于C組(P<0.05)。結論：右美託咪啶複閤芬太尼用于開胸手術後PCIA的效果優于單獨應用芬太尼。
목적：탐토우미탁미정대개흉수술환자술후분태니자공정맥진통효과적영향。방법：ASAⅠ~Ⅲ급택기행개흉수술환자40례,수궤분성2조,술후균행정맥자공진통( PCIA),진통약배방위분태니20μg/kg( C조),분태니20μg/kg+우미탁미정10μg/kg(D조),용0.9%록화납주사액희석지100 ml。초시부하제량2 ml,지속제량2 ml/h,단차정맥쾌주(Bolus)제량0.5 ml,쇄정시간15 min。기록각조환자술후24 h내Bolus총안압차수급분태니용량,술후4、8、24、48 h적진통시각모의평분화Ramsay진정평분,술후각조환자호흡억제、악심구토、심솔<50차/분,수축압<90 mmHg등불량반응적발생정황,우마취전、술후4、8、24 h측정혈청피질순농도；우술후48 h평개환자만의도。결과：여C조비교,D조술후24 h내Bolus총안압차수감소,분태니용량강저(P<0.01)；D조각시점Ramsay진정평분균교C조명현승고(P<0.01),D조술후4 h화8 h적진통시각모의평분균교C조강저(P<0.01화P<0.05)；2조환자호흡억제、악심구토발생솔급술후4~48 h피질순수평차이균무통계학의의(P>0.05),D조환자만의도고우C조(P<0.05)。결론：우미탁미정복합분태니용우개흉수술후PCIA적효과우우단독응용분태니。
Objective:To investigate the influence of dexmedetomidine on patient-controlled intravenous analgesia( PCIA) with fentanil after thoracic surgery. Methods:Forty ASAⅠ -Ⅲ patients scheduled for elective thoracic surgery were randomly divided into two groups( n =20, each) according to the PCIA formula. Group C received fentanil 20 μg/kg and group D fentanil 20 μg/kg plus dexmedetomidine 10 μg/kg;and the PCIA was diluted with 100 saline. The initial loading volume was 2 ml,background volume 2 ml/h and bolus dose 0. 5 ml;the lockout time was set to 15 min. The number of the pressing attempts,consumption of fentanil within 24 h,the visual analogue scales,and the Ramsay sedation scale at 4,8,24 and 48 h after surgery were recorded;the incidence of vomiting and respiration depression was also recorded. Blood samples were obtained before anesthesia,4,8 and 24 h after surgery for determination of serum cortisol concentration. The patients’satisfactory degree was evaluated 48 h after surgery. Results:Compared to group C,group D had a decreased number of PCIA pressing attempts and consumption of fentanil within 24 h after operation(P<0. 01);the Ramsay sedation scale of group D increased at 4,8,24 and 48 h after surgery;the visual analogue scales of group D decreased at 4 and 8 hour after surgery(P<0. 01 to P<0. 05). The incidence of respiratory inhibition vomiting and serum cortisol concentration after operation had no significant differences between the two groups(P>0. 05). The satisfaction degree of the patients in group D was significantly higher than that in group C(P <0. 05). Conclusions:The effect of combination use of dexmedetomidine and fentanil is superior to fentanil alone in PCIA after thoracic surgery.
