引用本文:邢海林,项 冬,李云祥,谢国柱.妇科肿瘤患者全子宫切除术后应用右美托咪定联合地佐辛硬膜外自控镇痛的疗效观察[J].中国临床新医学,2020,13(3):268-272.
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妇科肿瘤患者全子宫切除术后应用右美托咪定联合地佐辛硬膜外自控镇痛的疗效观察
邢海林,项 冬,李云祥,谢国柱
225300 江苏,南京医科大学泰州临床医学院,泰州市人民医院麻醉科
摘要:
[摘要] 目的 观察妇科肿瘤患者全子宫切除术后应用右美托咪定联合地佐辛硬膜外自控镇痛(PCEA)的疗效。方法 选取2016-01~2017-12行全子宫切除术患者123例,随机分为两组:右美托咪定组(D组,n=62例),右美托咪定80 μg+罗哌卡因200 mg+地佐辛5 mg加入生理盐水100 ml静滴;对照组(C组,n=61例),罗哌卡因200 mg+地佐辛5 mg加入生理盐水100 ml静滴。观察两组麻醉时间、手术时间、手术方式,术后清醒时T1(术后4 h)、T2(术后8 h)、T3(术后12 h)、T4(术后24 h)视觉模拟评分(Visual Analogue Score,VAS)、Ramsay镇静评分、脉氧饱和度(SpO2)、呼吸频率(RR)、平均动脉压(MAP)和心率(HR)的变化情况,并记录患者术后躁动、恶心、呕吐、呼吸抑制和皮肤瘙痒等不良反应以及患者术后镇痛满意程度。结果 两组患者VAS和Ramsay评分组间比较、各时点比较及组别与时点的交互作用差异均有统计学意义(P<0.05),D组患者的VAS和Ramsay镇静评分在T1、T2、T3、T4四个时点明显低于C组,差异有统计学意义(P<0.01)。两组患者HR的组间比较、各时点比较及组别与时点的交互作用差异均有统计学意义(P<0.05),而MAP、RR和SpO2则差异无统计学意义(P>0.05)。D组患者在T1、T2和T3三个时间点的HR明显低于C组,差异有统计学意义(P<0.01,P<0.01和P=0.047);D组患者没有出现术后躁动,C组患者则有6例,差异有统计学意义(P<0.05)。此外,D组患者的镇痛满意度为88.71%,显著高于C组的59.02%(P<0.01)。结论 妇科肿瘤患者全子宫切除术后应用右美托咪定联合地佐辛PCEA能提供更好的镇痛效果及满意度,同时减少不良反应。
关键词:  右美托咪定  全子宫切除  硬膜外自控镇痛  视觉模拟疼痛量表  Ramsay镇静评分
DOI:10.3969/j.issn.1674-3806.2020.03.14
分类号:R 737.33
基金项目:
Effect of dexmedetomidine combined with dezocine on patient-controlled epidural analgesia in patients with gynecological tumors after total hysterectomy
XING Hai-lin, XIANG Dong, LI Yun-xiang, et al.
Department of Anesthesiology, Taizhou People′s Hospital, Taizhou Clinical Medical College of Nanjing Medical University, Jiangsu 225300, China
Abstract:
[Abstract] Objective To observe the effect of dexmedetomidine combined with dezocine on patient-controlled epidural analgesia(PCEA) in patients with gynecological tumors after total hysterectomy. Methods One hundred and twenty-three patients undergoing total hysterectomy were selected in our hospital from January 2016 to December 2017, and were divided into the dexmedetomidine group(group D, treated with dexmedetomidine 80 μg+ropivacaine 200 mg+dezocine 5 mg, normal saline added to 100 ml, intravenous drip, n=62) and the control group(group C, treated with ropivacaine 200 mg+dezocine 5 mg, normal saline added to 100 ml, intravenous drip, n=61). The anesthesia time, operation time and operation mode were compared between the two groups. When the patients were awake after surgery, the changes of Visual Analogue Score(VAS), Ramsay Sedation Score, pulse oxygen saturation(SpO2), respiratory rate(RR), mean arterial pressure(MAP) and heart rate(HR) were observed at T1(4 hours after operation), T2(8 hours after operation), T3(12 hours after operation) and T4(24 hours after operation) in the patients of the two groups. The adverse reactions such as restlessness, nausea, vomiting, respiratory depression and pruritus were recorded, and the satisfaction degree of postoperative analgesia was also recorded. Results There were significant differences in the Visual Analogue Scores and Ramsay Sedation Scores between the two groups, among different time points and the interaction between the groups and the time points(P<0.05). Compared with those in group C, the Visual Analogue Scores and Ramsay Sedation Scores in group D were significantly decreased at T1, T2, T3 and T4 after surgery(P<0.01). In general analysis, there were significant differences in HRs between the two groups in inter-group comparison, time-point comparison and interaction between the two groups and time points(P<0.05), while there were no significant differences in MAP, RR and SpO2(P>0.05). The HR of group D was significantly lower than that of group C in the three time points of T1, T2 and T3(P<0.01, P<0.01 and P=0.047). There were no cases with postoperative restlessness in group D, and there were 6 cases with postoperative restlessness in group C, with a significant difference between the two groups(P<0.05). In addition, the satisfaction degree of postoperative analgesia of the patients in group D(88.71%) was significantly higher than that in group C(59.02%)(P<0.01). Conclusion Dexmedetomidine combined with dezocine provides better analgesic, effect and satisfaction after total hysterectomy in the patients with gynecological tumors, and reduces adverse reactions.
Key words:  Dexmedetomidine  Total hysterectomy  Patient-controlled epidural analgesia(PCEA)  Visual Analogue Pain Scale  Ramsay Sedation Score