不同剂量右美托咪定复合布托啡诺在术后镇痛中的效果比较
불동제량우미탁미정복합포탁배낙재술후진통중적효과비교
The effect comparison of different concentration dexmedetomidine with butorphanol on postoperative analgesia
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2013年 21期 29-32 ,共4页

    于颜锋%刘文养%覃勇华

    우안봉%류문양%담용화

    布托啡诺%镇痛%右美托咪啶 佈託啡諾%鎮痛%右美託咪啶
    포탁배낙%진통%우미탁미정
    Butorphanol%Analgesia%Dexmedetomidine
    目的 通过不同剂量右美托咪定复合布托啡诺术后镇痛效果和不良反应的观察,研究右美托咪定的最佳术后镇痛剂量.方法 选择择期全身麻醉下腹手术患者90例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为A、B、C三组,每组30例.患者自控镇痛泵药物配制:A组右美托咪定0.2 μg/ (kg·h)+布托啡诺0.15 mg/kg+昂丹司琼8 mg;B组右美托咪定0.3 μg/ (kg·h)+布托啡诺0.15 mg/kg+昂丹司琼8 mg;C组布托啡诺0.15 mg/kg+昂丹司琼8 mg.患者自控镇痛泵持续注药设定总量100ml,速率为2ml/h,自控镇痛量为2ml,锁定时间为30 min,各组术后镇痛均持续48 h.记录术后2、6、12、24、48 h的疼痛视觉模拟评分(VAS)和Ramsay镇静评分(RSS),不良反应,24h镇痛泵总按压次数和镇痛液总用量.结果 A组和B组术后各时间点VAS比较差异均无统计学意义(P＞0.05),但均明显低于C组[(2.7±0.8)、(2.6±0.8)分比(3.2±0.9)分,(1.8±0.6)、(1.7±0.6)分比(2.5±0.6)分,(1.0±0.6)、(0.9±0.7)分比(1.8±0.6)分,(1.0±0.5)、(0.8±0.5)分比(1.4±0.5)分,(0.7±0.5)、(0.7±0.4)分比(1.0±0.5)分],差异有统计学意义(P＜0.05).三组术后2 h RSS比较差异均无统计学意义(P＞0.05)；A组和B组术后6、12、24、48 h RSS均高于C组[(2.6±0.5)、(3.5±0.6)分比(2.0±0.3)分,(2.9±0.6)、(3.8±1.2)分比(2.4±0.3)分,(2.8±0.7)、(3.9±0.7)分比(2.5±0.4)分,(2.8±0.6)、(3.9±0.6)分比(2.5±0.5)分],且B组高于A组,差异均有统计学意义(P＜0.05).三组低氧血症发生率比较差异均无统计学意义(P＞0.05)；A组和B组恶心呕吐和谵妄发生率明显低于C组[3.3％(1/30)和0比10.0％(3/30)、0和0比10.0％(3/30)],但B组低血压和心动过缓发生率明显高于A组和C组[16.7％(5/30)比3.3％(1/30)和0、20.0％(6/30)比3.3％(1/30)和0],差异均有统计学意义(P＜0.05).C组24 h镇痛泵总按压次数和镇痛液总用量明显大于A组和B组[(13.9±2.4)次比(9.7±2.2)、(7.4±1.5)次,(60.9±1.8) ml比(54.5±1.2)、(50.7±0.7) ml],差异均有统计学意义(P＜0.05).结论 0.2μg/(kg·h)右美托咪定复合布托啡诺用于术后镇痛、镇静效果较好,不良反应少.
    목적 통과불동제량우미탁미정복합포탁배낙술후진통효과화불량반응적관찰,연구우미탁미정적최가술후진통제량.방법 선택택기전신마취하복수술환자90례,ASA분급Ⅰ～Ⅱ급,안수궤수자표법분위A、B、C삼조,매조30례.환자자공진통빙약물배제:A조우미탁미정0.2 μg/ (kg·h)+포탁배낙0.15 mg/kg+앙단사경8 mg;B조우미탁미정0.3 μg/ (kg·h)+포탁배낙0.15 mg/kg+앙단사경8 mg;C조포탁배낙0.15 mg/kg+앙단사경8 mg.환자자공진통빙지속주약설정총량100ml,속솔위2ml/h,자공진통량위2ml,쇄정시간위30 min,각조술후진통균지속48 h.기록술후2、6、12、24、48 h적동통시각모의평분(VAS)화Ramsay진정평분(RSS),불량반응,24h진통빙총안압차수화진통액총용량.결과 A조화B조술후각시간점VAS비교차이균무통계학의의(P＞0.05),단균명현저우C조[(2.7±0.8)、(2.6±0.8)분비(3.2±0.9)분,(1.8±0.6)、(1.7±0.6)분비(2.5±0.6)분,(1.0±0.6)、(0.9±0.7)분비(1.8±0.6)분,(1.0±0.5)、(0.8±0.5)분비(1.4±0.5)분,(0.7±0.5)、(0.7±0.4)분비(1.0±0.5)분],차이유통계학의의(P＜0.05).삼조술후2 h RSS비교차이균무통계학의의(P＞0.05)；A조화B조술후6、12、24、48 h RSS균고우C조[(2.6±0.5)、(3.5±0.6)분비(2.0±0.3)분,(2.9±0.6)、(3.8±1.2)분비(2.4±0.3)분,(2.8±0.7)、(3.9±0.7)분비(2.5±0.4)분,(2.8±0.6)、(3.9±0.6)분비(2.5±0.5)분],차B조고우A조,차이균유통계학의의(P＜0.05).삼조저양혈증발생솔비교차이균무통계학의의(P＞0.05)；A조화B조악심구토화섬망발생솔명현저우C조[3.3％(1/30)화0비10.0％(3/30)、0화0비10.0％(3/30)],단B조저혈압화심동과완발생솔명현고우A조화C조[16.7％(5/30)비3.3％(1/30)화0、20.0％(6/30)비3.3％(1/30)화0],차이균유통계학의의(P＜0.05).C조24 h진통빙총안압차수화진통액총용량명현대우A조화B조[(13.9±2.4)차비(9.7±2.2)、(7.4±1.5)차,(60.9±1.8) ml비(54.5±1.2)、(50.7±0.7) ml],차이균유통계학의의(P＜0.05).결론 0.2μg/(kg·h)우미탁미정복합포탁배낙용우술후진통、진정효과교호,불량반응소.
    Objective Through the effect comprison of analgesic calm and side-effect on postoperative analgesia under different concentration dexmedetomidine with butorphanol,to research the best concentration of dexmedetomidine on postoperative analgesia.Methods Ninety patients with lower abdominal surgery with general anesthesia,ASA Ⅰ-Ⅱ grade,were divided into 3 groups by random digits table:group A,group B and group C,each group with 30 cases.The group A received 0.2 μg/ (kg·h) dexmedetomidine.The group B received 0.3 μg/ (kg ·h) dexmedetomidine,both added 0.15 mg/kg butorphanol and 8 mg ondansetron.The group C only received 0.15 mg/kg butorphanol and 8 mg ondansetron.Applied patient controlled intravenous analgesia (PCIA) pump continuous infusion gave total 100 ml,background infusion 2 ml/h,patient controlled analgesia (PCA) 2 ml,lock time 30 min,analgesia was continued 48 h.Below were recorded at 2,6,12,24 and 48 h after the beginning of PCIA:analgesia VAS score,ramsay sedation scale (RSS),adverse reaction.The total number of button pressing of PCA and the consumption of patient controlled liqnid analgesia (PCLA) solution were also recorded.Results There was no statistically significant difference in VAS score after each time point between group A and group B (P＞ 0.05).The VAS scores after each time point in group A and group B were significantly lower than those in group C [(2.7 ±0.8),(2.6 ± 0.8) scores vs.(3.2 ± 0.9) scores; (1.8 ± 0.6),(1.7 ± 0.6) scores vs.(2.5 ± 0.6) scores; (1.0 ±0.6),(0.9 ±0.7) scores vs.(1.8 ±0.6) scores; (1.0 ±0.5),(0.8 ±0.5) scores vs.(1.4 ±0.5) scores; (0.7 ±0.5),(0.7 ±0.4) scores vs.(1.0 ±0.5) scores,P ＜0.05].There was no statistically significant difference in RSS score among 3 groups (P ＞ 0.05).The RSS scores after 6,12,24 and 48 h in group A and group B were significantly higher than those in group C [(2.6 ±0.5),(3.5 ±0.6) scores vs.(2.0 ±0.3) scores; (2.9 ± 0.6),(3.8 ± 1.2) scores vs.(2.4 ± 0.3) scores; (2.8 ± 0.7),(3.9 ± 0.7) scores vs.(2.5 ± 0.4)scores; (2.8 ± 0.6),(3.9 ± 0.6) scores vs.(2.5 ± 0.5) scores,P ＜ 0.05],group A was significantly higher than those in group B (P＜ 0.05).There was no statistically significant difference in rate of hypoxemia among 3 groups (P ＞ 0.05).The rates of nausea and vomit,deliration in group A and group B were significantly lower than those in group C [3.3％(1/30),0 vs.10.0％(3/30) ;0,0 vs.10.0％(3/30),P＜ 0.05].The rates of hypotension and bradycardia in group B were significantly lower than those in group A and group C[16.7％ (5/30) vs.3.3％(1/30),0;20.0％(6/30) vs.3.3％(1/30),0,P＜ 0.05].The total number of button pressing of PCA 24 h and the consumption of PCLA solution in group C were significantly higher than those in group A and group B [(13.9 ±2.4) times vs.(9.7 ±2.2),(7.4 ± 1.5) times; (60.9 ± 1.8) ml vs.(54.5 ± 1.2),(50.7 ± 0.7) ml,P ＜ 0.05].Conclusion Concentration 0.2 μ g/(kg· h) dexmedetomidine with butorphanol has better effects on postoperative analgesia and calm,less side-effect.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문