CAJ | 학술논문

目的观察不同剂量的右美托咪定(dexmedetomidine,Dex)与罗哌卡因、芬太尼用于剖宫产术后自控硬膜外镇痛(patient controlled epidural analgesia,PCEA)的效果、应激反应及安全性. 方法将80例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级行剖宫产术后镇痛的患者,根据Dex不同剂量采用随机数字表法随机分为4组(每组20例):A组(0)、B组(0.5 mg/L)、C组(0.8 mg/L)、D组(1.5 mg/L),A组为对照组,其余组为实验组;4组分别联合罗哌卡因(1.5 g/L)与芬太尼(2 mg/L)行PCEA.记录术后各时点6、12、24、48 h的镇痛视觉模拟(visual analogue scale,VAS)评分、用药量、总按压次数、有效按压次数、平均动脉压、心率、感觉、运动阻滞程度(Bromage评分)、镇静程度(Ramsay评分)及副作用(恶心、呕吐、皮肤瘙痒、术后寒战等).记录术前及术后各时点6、12、24、48 h的皮质醇(cortisol,Cor)和血糖(blood glucose,Glu)数值. 结果 B、C、D组VAS评分在各时间点均明显低于对照组(A组)(P＜0.05),其中术后12h时B、C组静态VAS分值[(1.7±0.9),(1.6±0.6)]、动态VAS分值[(3.3±0.7),(3.4±0.5)]比较差异有统计学意义,而B组和C组差异无统计学意义(P＞0.05).各组各时点Cor和Glu指标:B、C两组术后12hCor[(26.3±7.6)、(26.2±8.3) mg/L]和术后6 h Glu[(6.4±2.4)、(6.2±2.4) mmol/L]与A组比较,差异有统计学意义(P＜0.05).48 h时总用药量、总按压次数、有效按压次数,A组明显高于其他组(P＜0.05).另外4组平均血压、双下肢运动未见明显异常,对照组A副作用率明显高于其他组.但D组有4例患者局部皮肤麻木感,有l例患者嗜睡,有1例患者出现心动过缓. 结论 Dex辅助用于剖宫产术后硬膜外镇痛时,明显增加了术后镇痛效果,减轻了机体应激反应,降低了副作用发生率和总用药量.Dex在浓度0.5 mg/L～0.8 mg/L时,其镇痛效果、应激反应、副作用发生率差异均无统计学意义,并且安全. 目的觀察不同劑量的右美託咪定(dexmedetomidine,Dex)與囉哌卡因、芬太尼用于剖宮產術後自控硬膜外鎮痛(patient controlled epidural analgesia,PCEA)的效果、應激反應及安全性. 方法將80例美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級行剖宮產術後鎮痛的患者,根據Dex不同劑量採用隨機數字錶法隨機分為4組(每組20例):A組(0)、B組(0.5 mg/L)、C組(0.8 mg/L)、D組(1.5 mg/L),A組為對照組,其餘組為實驗組;4組分彆聯閤囉哌卡因(1.5 g/L)與芬太尼(2 mg/L)行PCEA.記錄術後各時點6、12、24、48 h的鎮痛視覺模擬(visual analogue scale,VAS)評分、用藥量、總按壓次數、有效按壓次數、平均動脈壓、心率、感覺、運動阻滯程度(Bromage評分)、鎮靜程度(Ramsay評分)及副作用(噁心、嘔吐、皮膚瘙癢、術後寒戰等).記錄術前及術後各時點6、12、24、48 h的皮質醇(cortisol,Cor)和血糖(blood glucose,Glu)數值. 結果 B、C、D組VAS評分在各時間點均明顯低于對照組(A組)(P＜0.05),其中術後12h時B、C組靜態VAS分值[(1.7±0.9),(1.6±0.6)]、動態VAS分值[(3.3±0.7),(3.4±0.5)]比較差異有統計學意義,而B組和C組差異無統計學意義(P＞0.05).各組各時點Cor和Glu指標:B、C兩組術後12hCor[(26.3±7.6)、(26.2±8.3) mg/L]和術後6 h Glu[(6.4±2.4)、(6.2±2.4) mmol/L]與A組比較,差異有統計學意義(P＜0.05).48 h時總用藥量、總按壓次數、有效按壓次數,A組明顯高于其他組(P＜0.05).另外4組平均血壓、雙下肢運動未見明顯異常,對照組A副作用率明顯高于其他組.但D組有4例患者跼部皮膚痳木感,有l例患者嗜睡,有1例患者齣現心動過緩. 結論 Dex輔助用于剖宮產術後硬膜外鎮痛時,明顯增加瞭術後鎮痛效果,減輕瞭機體應激反應,降低瞭副作用髮生率和總用藥量.Dex在濃度0.5 mg/L～0.8 mg/L時,其鎮痛效果、應激反應、副作用髮生率差異均無統計學意義,併且安全.
목적 관찰불동제량적우미탁미정(dexmedetomidine,Dex)여라고잡인、분태니용우부궁산술후자공경막외진통(patient controlled epidural analgesia,PCEA)적효과、응격반응급안전성. 방법 장80례미국마취의사협회(ASA)분급Ⅰ～Ⅱ급행부궁산술후진통적환자,근거Dex불동제량채용수궤수자표법수궤분위4조(매조20례):A조(0)、B조(0.5 mg/L)、C조(0.8 mg/L)、D조(1.5 mg/L),A조위대조조,기여조위실험조;4조분별연합라고잡인(1.5 g/L)여분태니(2 mg/L)행PCEA.기록술후각시점6、12、24、48 h적진통시각모의(visual analogue scale,VAS)평분、용약량、총안압차수、유효안압차수、평균동맥압、심솔、감각、운동조체정도(Bromage평분)、진정정도(Ramsay평분)급부작용(악심、구토、피부소양、술후한전등).기록술전급술후각시점6、12、24、48 h적피질순(cortisol,Cor)화혈당(blood glucose,Glu)수치. 결과 B、C、D조VAS평분재각시간점균명현저우대조조(A조)(P＜0.05),기중술후12h시B、C조정태VAS분치[(1.7±0.9),(1.6±0.6)]、동태VAS분치[(3.3±0.7),(3.4±0.5)]비교차이유통계학의의,이B조화C조차이무통계학의의(P＞0.05).각조각시점Cor화Glu지표:B、C량조술후12hCor[(26.3±7.6)、(26.2±8.3) mg/L]화술후6 h Glu[(6.4±2.4)、(6.2±2.4) mmol/L]여A조비교,차이유통계학의의(P＜0.05).48 h시총용약량、총안압차수、유효안압차수,A조명현고우기타조(P＜0.05).령외4조평균혈압、쌍하지운동미견명현이상,대조조A부작용솔명현고우기타조.단D조유4례환자국부피부마목감,유l례환자기수,유1례환자출현심동과완. 결론 Dex보조용우부궁산술후경막외진통시,명현증가료술후진통효과,감경료궤체응격반응,강저료부작용발생솔화총용약량.Dex재농도0.5 mg/L～0.8 mg/L시,기진통효과、응격반응、부작용발생솔차이균무통계학의의,병차안전.
Objective To observe the effects,stress response and safety of different doses of dexmedetomidine (Dex) on epidural analgesia after caesarean section.Methods According to different doses of the Dex,80 cesarean section patients with ASA Ⅰ-Ⅱ were averagely divided into four groups by random number table method:A(0),B(0.5 mg/L),C(0.8 mg/L),D(1.5 mg/L),with A being the control group.Every group was separately combined with 0.15％ ropivacaine and fentanyl (2 mg/L) for patient controlled epidural analgesia(PCEA).The visual analogue scale (VAS),drug consumption,total press numbers,effective press numbers,mean arterial pressure,heart rate,sensation,Motor block level(Bromage score),Sedation degree(Ramsay score) at 6,12,24,48 h after caesarean section and the side effect(nausea and vomiting and pruritis,shiver etc) were recorded.The date of the cortisol(Cor) and blood glucose (Glu)at preoperative and 6,12,24,48 h after caesarean section was also recorded.Results B,C,D groups showed lower scorc than A group in visual analogue scale(P＜0.05) and the difference between static VAS score[(1.7±0.9),(1.6±0.6)] and dynamic VAS score[(3.3±0.7),(3.4±0.5)] of B and C groups had remarkable statistical significance 12 h postoperatively,but there were no significance between B and C groups (P＞0.05).At 6,12 h Cor and Glu postoperatively there was an evident statistical significance (P＜0.05) between B,C groups and A group.Compared with 48 h drug consumption,total press numbers,effective press numbers,A group is significantly higher than other groups (P＜0.05),while B group and C group had no statistical significance (P＞0.05).Besides,There were no obvious abnormal in the average blood pressure and the motion function of both lower extremities.Moreover,adverse reaction rate of A group is significantly higher than other groups.In D group,4 cases suffered from local skin numbness,1 case lethargy and 1 case bradycardia.Conclusions Dex significantly enhanced the effect of analgesia,decreased stress response and reduced adverse reaction rate and total drug comsunption on epidural analgesia after caesarean section.The experiment also showed concentration of dexmedetomidine in 0.5 mg/L-0.8 mg/L was same effect of epidural analgesia and the more safety with comparison of concentration of dexmedetomidine in 0.8 mg/L-1.5 mg/L.