右美托咪啶复合布托啡诺在术后患者自控镇痛中的应用

摘要

目的：观察并评价右美托咪啶复合布托啡诺用于腹腔镜下胆囊切除术后患者自控静脉镇痛（PCIA）的临床效果及安全性。方法选取ASAⅠ～Ⅱ级，择期在全身麻醉下行腹腔镜下胆囊切除术的患者90例，随机分为3组，每组30例。A组采用布托啡诺10 mg+阿扎司琼10 mg，B组采用布托啡诺15 mg+阿扎司琼10 mg，C组采用布托啡诺10 mg+右美托咪啶200μg+阿扎司琼10 mg；均用生理盐水稀释至100 ml，背景输注速率2 ml/h，单次给药剂量1 ml，锁定时间15 min。所有患者均在手术结束前缓慢静脉注射布托啡诺1 mg，术后行PCIA。观察并记录术后4 h、12 h、24 h及48 h的平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）、VAS评分、Ramsay镇静评分、追加补救镇痛药例数，48h镇痛泵总按压次数以及术后镇痛期间不良反应发生情况，于术后48 h评价患者满意度。结果3组患者各时间点MAP和SpO2比较，差异无统计学意义（>0.05）， C组患者的HR在术后4 h、12 h、24 h及48 h均显著低于A组和B组（<0.05）。B组和C组术后4 h、12 h及24 h的VAS评分均明显低于同时间点A组（<0.05）；B组和C组镇痛泵总按压次数明显少于A组，C组又明显少于B组（<0.05）；A、C组总不良反应发生率明显低于B组（<0.05），C组又明显低于A组（<0.05）；C组术后镇痛的满意度显著高于A组和B组（<0.05）。结论右美托咪啶复合布托啡诺用于腹腔镜下胆囊切除术后患者自控镇痛效果满意，可减少布托啡诺用量，降低不良反应发生率，提高患者对术后镇痛满意度。%Objective To evaluate the effect of Dexmedetomidine combined with Butorphanol for postoperative patient-controlled intravenous analgesia (PCIA). Methods Ninety patients scheduled for laparoscopic cholecystectomy were randomly divided into three groups (30 in each). The patients in the group A received Butorphanol 10 mg com-bined with Azasetron 10 mg, the patients in the group B received Butorphanol 15 mg combined with Azasetron 10 mg, the patients in the group C received Butorphanol 10 mg combined with Dexmedetomidine 200 μg and Azasetron 10 mg. The analgesic pump was set in all the groups as follows: background infusion rate 2 ml/h, single bolus dose 1 ml, lockout interval 15 min, with the total volume of 100 ml. Butorphanol 1 mg was given before the end of the operation and PCIA was performed in all the patients after operation. MAP, SpO2, HR, VAS scores, Ramsay sedation scores, and the number of patients requiring rescue analgesics were recorded at 4, 12, 24 and 48 h after operation. The total pressing times of the PCA button, the overall satisfaction of analgesia and postoperative compli-cations were recorded 48 h after operation. Results There was no significant difference in MAP or SpO2 at various time among the three groups ( >0.05). The HR in the group C was significantly lower than that in the groups A and B at 4, 12, 24 and 48 h after surgery ( < 0.05). The VAS scores of the groups B and C at 4, 12 and 24 h after surgery were lower than the corresponding ones of the group A ( < 0.05). The total pressing times of the analgesic pump in the groups B and C were fewer than those in the group A ( <0.05). The overall incidence of adverse reac-tions in the group C was significantly lower than that in the group A which was in turn lower than the incidence in the group B ( <0.05). The postoperative analgesia satisfaction of the patients in the group C was significantly high-er than that in the groups A and B ( < 0.05). Conclusions Combination of Dexmedetomidine with Butorphanol has satisfactory analgesic effect for PCIA, can reduce the consumption of Butorphanol and decrease the incidence of ad-verse reactions.