皖南医学院学报
皖南醫學院學報
환남의학원학보
ACTA ACADEMIAE MEDICINAE WANNAN
2014年
6期
549-551
,共3页
腔镜甲状腺手术%右旋美托咪定%术后镇痛
腔鏡甲狀腺手術%右鏇美託咪定%術後鎮痛
강경갑상선수술%우선미탁미정%술후진통
endoscopic thyroidectomy%dexmedetomidine%postoperative analgesia
目的：观察右美托咪定对腔镜甲状腺手术患者术后静脉镇痛（ PCIA ）的镇痛效果及其对术后不良反应的影响。方法：选择腔镜甲状腺切除手术患者40例，随机均分为两组。 A组手术结束前15 min静脉缓慢推注生理盐水作为负荷量，手术结束即刻行PCIA（枸橼酸舒芬太尼100μg+格拉斯琼6 mg）；B组手术结束前15 min静脉缓慢推注右美托咪定0.8μg／kg作为负荷量，手术结束即刻行PCIA（右美托咪定200μg+格拉斯琼6 mg）。记录术后2 h、4 h、8 h、24 h、48 h的VAS镇痛、Ramsay镇静评分，观察患者术后恶心呕吐、心动过缓、低血压或高血压、呼吸抑制及低氧血症等不良反应发生的例数和比率。结果：B组患者VAS镇痛评分、Ramsay镇静评分优于A组，其差异有统计学意义（P＜0.05）；且B组术后恶心呕吐等不良反应的发生率明显低于A组（P＜0.05）。结论：右美托咪定可为腔镜甲状腺切除手术患者提供良好的镇静、镇痛作用，且不良反应少，可以安全有效地用于腔镜甲状腺切除手术患者的术后镇痛。
目的：觀察右美託咪定對腔鏡甲狀腺手術患者術後靜脈鎮痛（ PCIA ）的鎮痛效果及其對術後不良反應的影響。方法：選擇腔鏡甲狀腺切除手術患者40例，隨機均分為兩組。 A組手術結束前15 min靜脈緩慢推註生理鹽水作為負荷量，手術結束即刻行PCIA（枸櫞痠舒芬太尼100μg+格拉斯瓊6 mg）；B組手術結束前15 min靜脈緩慢推註右美託咪定0.8μg／kg作為負荷量，手術結束即刻行PCIA（右美託咪定200μg+格拉斯瓊6 mg）。記錄術後2 h、4 h、8 h、24 h、48 h的VAS鎮痛、Ramsay鎮靜評分，觀察患者術後噁心嘔吐、心動過緩、低血壓或高血壓、呼吸抑製及低氧血癥等不良反應髮生的例數和比率。結果：B組患者VAS鎮痛評分、Ramsay鎮靜評分優于A組，其差異有統計學意義（P＜0.05）；且B組術後噁心嘔吐等不良反應的髮生率明顯低于A組（P＜0.05）。結論：右美託咪定可為腔鏡甲狀腺切除手術患者提供良好的鎮靜、鎮痛作用，且不良反應少，可以安全有效地用于腔鏡甲狀腺切除手術患者的術後鎮痛。
목적：관찰우미탁미정대강경갑상선수술환자술후정맥진통（ PCIA ）적진통효과급기대술후불량반응적영향。방법：선택강경갑상선절제수술환자40례，수궤균분위량조。 A조수술결속전15 min정맥완만추주생리염수작위부하량，수술결속즉각행PCIA（구연산서분태니100μg+격랍사경6 mg）；B조수술결속전15 min정맥완만추주우미탁미정0.8μg／kg작위부하량，수술결속즉각행PCIA（우미탁미정200μg+격랍사경6 mg）。기록술후2 h、4 h、8 h、24 h、48 h적VAS진통、Ramsay진정평분，관찰환자술후악심구토、심동과완、저혈압혹고혈압、호흡억제급저양혈증등불량반응발생적례수화비솔。결과：B조환자VAS진통평분、Ramsay진정평분우우A조，기차이유통계학의의（P＜0.05）；차B조술후악심구토등불량반응적발생솔명현저우A조（P＜0.05）。결론：우미탁미정가위강경갑상선절제수술환자제공량호적진정、진통작용，차불량반응소，가이안전유효지용우강경갑상선절제수술환자적술후진통。
Objective:To observe the efficacy and adverse effects of dexmedetomidine for patients-controlled intravenous analgesia(PCIA) in patients after endoscopic thyroidectomy.Methods:Forty patients undergoing elective endoscopic thyroidectomy were equally randomized into 2 groups.The patients in group A received normal saline as load capacity 15 min before the procedure completion via intravenous bolus,followed by PCIA(100 μg sufentanil citrate+6 mg granisetron) right at the end of the surgery,and those in group B were managed with dexmedetomidine in dose of 0.8 μg/kg 15 min before surgery completion.PCIA(200 μg dexmedetomidine+6 mg granisetron)was performed immediately after the procedure.The Visual Analog Scale(VAS) and Ram-say Sedation Score( RSS) were maintained at postoperative 2 h,4 h,8 h,24 h and 48 h,respectively,and the two groups were also observed regarding the postoperative adverse events,including the case incidence and ratio of nausea and vomiting,bradycardia,hypotension,hypertension,respiratory depression and hyoxemia.Results:Group B had significantly improved scores of VAS and RSS and lower incidences of postoperative adverse events than group A ( P<0.05).Conclusion:Dexmedetomidine can be safe and effective PCIA for patients undergoing endoscopic thyroidectomy,for it may achieve better seda-tion and analgesic effects,yet reduce the side effects.
