右美托咪定复合舒芬太尼用于老年胃癌患者腹腔镜根治术术后镇痛效果观察

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摘要目的探讨右美托咪定复合舒芬太尼用于老年胃癌患者腹腔镜根治术后的镇痛效果。方法选取2016年1~12月在上海交通大学医学院附属仁济医院南院拟行择期腹腔镜根治术的胃癌患者，经过纳入、排除标准删选后90例，按照随机盲法，分为三组，每组各30例。对照组（S组）：舒芬太尼（2 μg/kg）+胃复安（20 mg）；右美托咪啶低剂量组（D1组）：右美托咪定（1 μg/kg）+舒芬太尼（2 μg/kg）+胃复安（20 mg）；右美托咪定高剂量组（D2组）：右美托咪定（2 μg/kg）+舒芬太尼（2 μg/kg）+胃复安。观察三组患者术后1 h（T1）、2 h（T2）、6 h（T3）、12 h（T4）、24 h（T5）、48 h（T6）的疼痛程度[视觉模拟评分（VAS评分）]、镇静程度（Ramsay评分），并比较三组患者术后的不良反应。结果三组患者术后T1、T2、T3、T4、T5、T6时间点VAS评分逐渐降低（P < 0.05），且T2~T6各时间段D1、D2组VAS评分显著低于S组，差异有统计学意义（P < 0.05），T3~T6时间段，D2组的VAS评分明显低于D1组，差异有统计学意义（P < 0.05）；三组患者术后T1、T2、T3、T4、T5、T6时间点Ramsay评分逐渐增高，且T5、T6时间点的D1、D2组Ramsay评分均比S组高，差异有统计学意义（P < 0.05）。三组患者之间恶心、呕吐、窦性心动过缓、嗜睡等不良反应发生率比较，差异无统计学意义（P > 0.05），且三组患者均无明显的呼吸抑制。结论右美托咪定与舒芬太尼存在协同作用，复合使用可明显降低患者的镇痛评分，同时不增加呼吸抑制、恶心呕吐等并发症的风险，可安全有效地用于老年胃癌患者腹腔镜根治术的术后镇痛。

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	董海平张磊王震虹

关键词 ：右美托咪定, 舒芬太尼, 术后镇痛, 静脉, 镇静

Abstract：Objective To explore the analgesic effect of Dexmedetomidine combined with Sufentanil on cancer postoperative analgesia of elderly patients with gastric cancer in laparoscopic radical resection. Methods Patients with gastric cancer selected period to receive laparoscopic radical resection surgery from January to December 2016 in Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital South Hospital. After the inclusion and exclusion criteria, the total of 90 patients were selected and divided into three groups according to randomized blind method, with 30 cases in each group. Control group (group S)： Sufentanil (2 g/kg) + Metoclopramide (20 mg); Dexmedetomidine group with low concentration (group D1)： Dexmedetomidine (1 μg/kg) + Sufentanil (2 g/kg) + Metoclopramide 20 mg; Dexmedetomidine group with high concentration (group D2)： Dexmedetomidine (2 g/kg) + Shufentanyl (2 g/kg) + Metoclopramide 20 mg. The degrees of pain (VAS scores) and sedation (Ramsay scores) were observed after operation of 1 (T1), 2 (T2), 6 (T3), 12 (T4), 24 h (T5) and 48 h (T6), and adverse reaction rates among these three groups were compared. Results VAS scores of three groups gradually decreased significantly at postoperative T1, T2, T3, T4, T5 and T6. VAS scores of the D1, Group D2 were significantly lower than those in group S at postoperative T2 to T6, and differences were statistically significant (P < 0.05). There were statistically significant differences that VAS scores of group D2 were apparently lower than those in group D1 at postoperative T3 to T6 (P < 0.05). Ramsay scores of three groups increased gradually at postoperative T1, T2, T3, T4, T5 and T6 with a significant difference, and Ramsay scores of group D1 and D2 were significantly higher than those in group S at postoperative T5 and T6, with statistically significant differences (P < 0.05). There were no statistically significant differences at the incidence of nausea, vomiting, sinus bradycardia, somnolence and other adverse reactions among three groups (P > 0.05), and there were no obvious respiratory depression happened. Conclusion The synergistic effect of Dexmedetomidine and Sufentanil, can significantly reduce the patients′ pain scores, and doesn’t increase the risk of respiratory depression, nausea and vomiting as well as other complications, which could be considered as a safe and effective method forpostoperative analgesia of elderly patients with gastric cancer in laparoscopic radical resection.

Key words： Dexmedetomidine Sufentanil Postoperative analgesia Intravenous Sedation

基金资助:国家自然科学基金资助项目（81300996）。

通讯作者: 王震虹（1976.7-），女，博士，副主任医师；研究方向：脑缺血再灌注损伤后的脑保护及右美的脑保护作用。

引用本文:

董海平张磊王震虹. 右美托咪定复合舒芬太尼用于老年胃癌患者腹腔镜根治术术后镇痛效果观察[J]. 中国医药导报, 2018, 15(7): 98-102.
DONG Haiping ZHANG Lei WANG Zhenhong. Effect of different concentrations of Dexmedetomidine combined with Sufentanil on cancer postoperative analgesia of elderly patients with gastric cancer in laparoscopic radical resection. 中国医药导报, 2018, 15(7): 98-102.

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