不同剂量右美托咪定联合帕瑞昔布在脑膜瘤切除术患者中应用效果的对比研究

摘要

目的 比较不同剂量右美托咪定联合帕瑞昔布在脑膜瘤切除术患者中的应用效果.方法 选取2014年9月-2015年3月在深圳市第二人民医院行脑膜瘤切除术的患者100例,随机分为对照组、D1组、D2组、D3组,每组25例.4组患者均于关闭硬脑膜后给予帕瑞昔布40 mg,D1组患者于手术结束前10 min给予右美托咪定0.25μg/kg,D2组患者于手术结束前10 min给予右美托咪定0.5μg/kg,D3组患者于手术结束前10 min给予右美托咪定1.0μg/kg.比较4组患者拔管时、拔管后10 min平均动脉压(MAP)、心率(HR)、视觉模拟评分法(VAS)评分,手术时间、自主呼吸恢复时间、拔管时间及不良反应发生情况.结果 4组患者拔管时MAP比较,差异无统计学意义(P＞0.05);拔管时D1组、D2组、D3组患者HR低于对照组,D3组患者HR低于D1组、D2组(P＜0.05).拔管后10min,D1组、1D2组、D3组患者MAP、HR低于对照组,D3组患者MAP、HR低于D1组、D2组(P＜0.05).拔管时及拔管后10 min,D1组、D2组、D3组患者VAS评分低于对照组,D2组、D3组患者VAS评分低于D1组,D3组患者VAS评分低于D2组(P＜0.05).4组患者手术时间比较,差异无统计学意义(P＞0.05).D1组、D2组、D3组患者自主呼吸恢复时间、拔管时间短于对照组,D3组患者自主呼吸恢复时间、拔管时间短于D1组、D2组(P＜0.05).D1组、D2组、D3组患者心动过缓发生率低于对照组,D3组患者恶心、躁动发生率低于对照组(P＜0.05).4组患者呛咳发生率比较,差异无统计学意义(P＞0.05).结论 与0.25μg/kg、0.5μg/kg右美托咪定相比,1.0 μg/kg右美托咪定联合帕瑞昔布在脑膜瘤切除术患者中的应用效果较好,安全性较高.%Objective To compare the application effect in patients undergoing meningioma resection in different doses of dexmedetomidine combined with parecoxib.Methods A total of 100 patients undergoing meningioma resection were selected in the Second People's Hospital of Shenzhen from September 2014 to March 2015,and they were randomly divided into A group,B group,C group and D group,each of 25 cases.Patients of the four groups received parecoxib (40 mg) after closing of endocranium,meanwhile patients of B group received low-dose dexmedetomidine (0.25 μg/kg) before 10 minutes of the end of surgery,patients of C group received medium-dose dexmedetomidine (0.5 μg/kg) before 10 minutes of the end of surgery,while patients of D group received high-dose dexmedetomidine (1.0 μg/kg) before 10 minutes of the end of surgery.MAP,HR and VAS score at extubation and after 10 minutes of extubation,duration of surgery,recovery time of autonomous respiration,extubation time and incidence of adverse reactions were compared between the two groups.Results No statistically significant differences of MAP was found among the four groups at extubation (P ＞ 0.05);at extubation,HR of B group,C group and D group was statistically significantly lower than that of A group,respectively,meanwhile HR of D group was statistically significantly lower than that of B group and C group,respectively (P ＜ 0.05).After 10 minutes of extubation,MAP and HR of B group,C group and D group were statistically significantly lower than those of A group,meanwhile MAP and HR of D group were statistically significantly lower than those of B group and C group (P ＜ 0.05).At extubation and after 10 minutes of extubation,VAS score of B group,C group and D group was statistically significantly lower than that of A group,respectively,VAS score of C group and D group was statistically significantly lower than that of B group,respectively,meanwhile VAS score of D group was statistically significantly lower than that of C group,respectively (P ＜ 0.05).No statistically significant differences of duration of surgery was found-among the four groups (P ＞ 0.05).Recovery time of autonomous respiration and extubation time of B group,C group and D group were statistically significantly shorter than those of A group,meanwhile recovery time of autonomous respiration and extubation time of D group were statistically significantly shorter than those of B group and C group (P ＜ 0.05).Incidence of bradycardia of B group,C group and D group was statistically significantly lower than that of A group respeceively (P ＜ 0.05);incidence of nausea and dysphoria of D group was statistically significantly lower than that of A group (P ＜ 0.05).No statistically significant differences of incidence of irritating cough was found among the four groups (P ＞ 0.05).Conclusion Compared with low-dose dexmedetomidine (0.25 μg/kg) and medium-dose dexmedetomidine (0.5 μg/kg),high-dose dexmedetomidine (1.0 μg/kg) combined with parecoxib has better application effect and higher safety in patients undergoing meningioma resection.