地佐辛联合右美托咪定用于术后自控镇痛的临床研究
지좌신연합우미탁미정용우술후자공진통적림상연구
Application of dezocine combined with dexmedetomidine in patient controlled intravenous analgesia after abdominal surgery
  • 万方数据
    中国医药 중국의약
    China Medicine
    2015年 11期 1695-1699 ,共5页

    张小光%杨改生%鹿曼曼%李晓晶%杨继光

    장소광%양개생%록만만%리효정%양계광

    开腹手术%地佐辛%右美托咪定%镇痛,患者控制 開腹手術%地佐辛%右美託咪定%鎮痛,患者控製
    개복수술%지좌신%우미탁미정%진통,환자공제
    Celiotomy%Dezocine%Dexmedetomidine%Analgesia,patient-controlled
    目的 探讨地佐辛联合右美托咪定用于腹部手术患者术后自控镇痛(PCIA)的效果和安全性.方法 选择2014年3-11月解放军空军总医院拟行胃肠手术患者125例,按随机数字表法分为5组,各25例.A组给予地佐辛0.7 mg/kg;B组给予地佐辛0.7 mg/kg±右美托咪定1μg/kg;C组给予地佐辛0.7 mg/kg±右美托咪定2μg/kg;D组给予地佐辛1.0 mg/kg±右美托咪定1μg/kg;E组给予地佐辛1.0 mg/kg±右美托咪定2μg/kg.将药物加入0.9％氯化钠注射液中至总量为100 ml,同时加入格拉司琼9 mg,手术结束前30 min给予地佐辛负荷剂量5 mg±格拉司琼3 mg.镇痛泵设置为背景剂量2 ml/h,按压1次0.5 ml,按压后锁定时间15 min.记录并比较5组患者术后4、8、12、24和48 h的血压、心率、血氧饱和度、疼痛视觉模拟量表(VAS)评分、Ramsay镇静评分和不良反应发生情况.结果 A组术后各时点VAS评分均明显高于B、C、D、E组[4h:(4.36±0.66)分比(3.46±0.60)、(3.43±0.49)、(3.21±0.41)、(3.18±0.37)分;8 h:(4.32±0.62)分比(3.43±0.47)、(3.41±0.61)、(3.17±0.37)、(3.12±0.45)分;12 h:(4.47±0.48)分比(3.39±0.52)、(3.36±0.49)、(3.04±0.45)、(2.92±0.57)分;24 h:(4.39 ±0.50)分比(3.41±0.61)、(3.33±0.48)、(2.82±0.28)、(2.79±0.52)分;48 h:(4.36±0.51)分比(3.44±0.31)、(3.26±0.43)、(2.60±0.52)、(2.57 ±0.51)分;均P＜0.01],D组和E组VAS评分均明显低于B组和C组(均P ＜0.05).A组术后各时点Ramasy镇静评分均明显低于B、C、D、E组[4 h:(1.5±0.5)分比(2.6±0.5)、(2.9±0.5)、(2.8±0.3)、(3.4±0.8)分;8 h:(1.6±0.5)分比(2.5±0.5)、(2.9±0.6)、(2.8±0.4)、(3.3±0.5)分;12 h:(1.6±0.6)分比(2.3±0.5)、(2.9±0.4)、(2.6±0.5)、(3.3±0.4)分;24 h:(1.7±0.5)分比(2.3±0.5)、(2.9±0.9)、(2.4±0.5)、(3.3±0.4)分;48 h:(1.7±0.3)分比(2.2±0.4)、(2.8±0.4)、(2.4±0.5)、(3.4±0.5)分;均P＜0.01],E组Ramasy镇静评分高于B、C和D组(均P＜0.05).A组术后各时点血压和心率均明显高于其他各组,差异均有统计学意义(均P＜ 0.01).A、B、C、D、E各组各有8、3、2、3、1例发生恶心呕吐,A组发生率明显高于其他各组(P＜0.01).结论 地佐辛联合右美托咪定用于腹部手术术后PCIA效果满意,不良反应少,最佳剂量为地佐辛1.0 mg/kg±右美托咪定1μg/kg.
    목적 탐토지좌신연합우미탁미정용우복부수술환자술후자공진통(PCIA)적효과화안전성.방법 선택2014년3-11월해방군공군총의원의행위장수술환자125례,안수궤수자표법분위5조,각25례.A조급여지좌신0.7 mg/kg;B조급여지좌신0.7 mg/kg±우미탁미정1μg/kg;C조급여지좌신0.7 mg/kg±우미탁미정2μg/kg;D조급여지좌신1.0 mg/kg±우미탁미정1μg/kg;E조급여지좌신1.0 mg/kg±우미탁미정2μg/kg.장약물가입0.9％록화납주사액중지총량위100 ml,동시가입격랍사경9 mg,수술결속전30 min급여지좌신부하제량5 mg±격랍사경3 mg.진통빙설치위배경제량2 ml/h,안압1차0.5 ml,안압후쇄정시간15 min.기록병비교5조환자술후4、8、12、24화48 h적혈압、심솔、혈양포화도、동통시각모의량표(VAS)평분、Ramsay진정평분화불량반응발생정황.결과 A조술후각시점VAS평분균명현고우B、C、D、E조[4h:(4.36±0.66)분비(3.46±0.60)、(3.43±0.49)、(3.21±0.41)、(3.18±0.37)분;8 h:(4.32±0.62)분비(3.43±0.47)、(3.41±0.61)、(3.17±0.37)、(3.12±0.45)분;12 h:(4.47±0.48)분비(3.39±0.52)、(3.36±0.49)、(3.04±0.45)、(2.92±0.57)분;24 h:(4.39 ±0.50)분비(3.41±0.61)、(3.33±0.48)、(2.82±0.28)、(2.79±0.52)분;48 h:(4.36±0.51)분비(3.44±0.31)、(3.26±0.43)、(2.60±0.52)、(2.57 ±0.51)분;균P＜0.01],D조화E조VAS평분균명현저우B조화C조(균P ＜0.05).A조술후각시점Ramasy진정평분균명현저우B、C、D、E조[4 h:(1.5±0.5)분비(2.6±0.5)、(2.9±0.5)、(2.8±0.3)、(3.4±0.8)분;8 h:(1.6±0.5)분비(2.5±0.5)、(2.9±0.6)、(2.8±0.4)、(3.3±0.5)분;12 h:(1.6±0.6)분비(2.3±0.5)、(2.9±0.4)、(2.6±0.5)、(3.3±0.4)분;24 h:(1.7±0.5)분비(2.3±0.5)、(2.9±0.9)、(2.4±0.5)、(3.3±0.4)분;48 h:(1.7±0.3)분비(2.2±0.4)、(2.8±0.4)、(2.4±0.5)、(3.4±0.5)분;균P＜0.01],E조Ramasy진정평분고우B、C화D조(균P＜0.05).A조술후각시점혈압화심솔균명현고우기타각조,차이균유통계학의의(균P＜ 0.01).A、B、C、D、E각조각유8、3、2、3、1례발생악심구토,A조발생솔명현고우기타각조(P＜0.01).결론 지좌신연합우미탁미정용우복부수술술후PCIA효과만의,불량반응소,최가제량위지좌신1.0 mg/kg±우미탁미정1μg/kg.
    Objective To explore the effect and safety of combined application of dezocine and dexmedetomidine (DEX) in patient controlled intravenous analgesia (PCIA) after abdominal surgery.Methods Totally 125 patients undergoing gastrointestinal surgery from March to November 2014 were randomly divided into group A administrated with dezocine (0.7 mg/kg), group B administrated with dezocine (0.7 mg/kg) ± DEX (1 μg/kg),group C administrated with dezocine (0.7 mg/kg) ± DEX (2 μg/kg), group D administrated with dezocine (1.0 mg/kg) ± DEX (1 μg/kg), and group E administrated with dezocine (1.0 mg/kg) ± DEX (2 pμg/kg).All the anesthetic agents were diluted into 100 ml of 0.9％ sodium chloride, and 9 mg of granisetron was added additionally.A loading dose of dezocine (5 mg) and granisetron (3 mg) were infused intravenously 30 minutes before the end of operation.PCIA was fixed as background dose of 2 ml/h, dose of 0.5 ml/once and lock time of 15 min.The visual analog scale (VAS), Ramsay sedation scores, heart rate, blood pressure, surplus pulse O2 and the adverse effects were observed and compared among groups 4 h, 8 h, 12 h, 24 h and 48 h after operation.Results The VAS scores in group A at all the time point after operation were significantly higher than those of group B, C, D and E [4 h: (4.36±0.66) scores vs (3.46±0.60), (3.43 ±0.49), (3.21 ±0.41),(3.18±0.37) scores;8 h: (4.32 ±0.62) scores vs (3.43 ±0.47), (3.41 ±0.61), (3.17 ±0.37),(3.12±0.45) scores;12 h: (4.47 ±0.48) scores vs (3.39±0.52), (3.36 ±0.49), (3.04±0.45),(2.92±0.57) scores;24 h: (4.39 ±0.50) scores vs (3.41 ±0.61), (3.33 ±0.48), (2.82 ±0.28),(2.79±0.52) scores;48 h: (4.36±0.51) scores vs (3.44±0.31), (3.26±0.43), (2.60±0.52),(2.57 ±0.51) scores] (all P ＜0.01);the scores in group D and E were all lower than those in group B and C (P ＜ 0.05).The Ramsay scores in group A at all the time point were significantly lower than those in group B, C,Dand E significantly [4 h: (1.5 ±0.5) scores vs (2.6 ±0.5), (2.9 ±0.5), (2.8 ±0.3), (3.4± 0.8) scores;8 h: (1.6±0.5) scores vs (2.5±0.5), (2.9±0.6), (2.8±0.4), (3.3±0.5) scores;12h:(1.6±0.6) scores vs (2.3 ±0.5), (2.9 ±0.4), (2.6 ±0.5), (3.3 ±0.4) scores;24 h: (1.7 ±0.5) scoresvs (2.3±0.5), (2.9±0.9), (2.4±0.5), (3.3 ±0.4) scores;48 h: (1.7 ±0.3) scores vs (2.2±0.4), (2.8±0.4), (2.4±0.5), (3.4±0.5) scores] (P＜0.01);the scores in group E were all significantly higher than those in group B, C and D (all P ＜ 0.05).The heart rate and blood pressure in group A were significantly higher than those of other groups(P ＜0.01).Nausea and vomiting occurred in 8 cases in group A, 3 cases in group B, 2 cases in group C, 3 cases in group D and 1 in group E;the incidence in group A was the highest (P ＜ 0.01).Conclusion Dezocine combined with DEX can offer favorable analgesic effect in PCIA after abdominal surgery with slight adverse effects;the optimal dose was 1.0 mg/kg of dezocine plus 1 μg/kg of DEX.
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