目的 探讨氟比洛芬酯联合右美托咪定用于食管癌根治术后镇痛的临床效果.方法 选取2014年3月至2015年3月于河南省胸科医院限期拟行食管癌根治术患者120例,采用随机数字表法分为3组,各40例.A组患者手术结束前30 min静脉给予氟比洛芬酯50 mg,术毕给予舒芬太尼2.5 g/kg+托烷司琼2 mg +0.9％氯化钠注射液共100 ml;B组患者手术结束前30 min静脉给予氟比洛芬酯50 mg,术毕给予舒芬太尼2.0 μg/kg+氟比洛芬酯150 mg+托烷司琼2 mg +0.9％氯化钠注射液共100 ml;C组患者手术结束前30 min静脉给予氟比洛芬酯50 mg,术毕给予舒芬太尼1.5 μg/kg+氟比洛芬酯150 mg+右美托咪定2.0 μg/kg+托烷司琼2 mg +0.9％氯化钠注射液共100 ml.3组术后持续镇痛量2ml/h,单次负荷剂量2ml,锁定时间15 min.记录并比较3组患者术前30 min (T0)、术后2 h(T1)、4 h(T2)、8 h(T3)、24 h(T4)及48 h(T5)心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、呼吸频率,T1～T5时点疼痛视觉模拟量表(VAS)评分及Ramsay镇静评分,术中镇痛药物包括舒芬太尼、瑞芬太尼等的用量及术后使用补救镇痛药物患者例数,术后48 h内自控镇痛平均按压次数,以及术后不良反应发生率.结果 A组患者术后T1、T2、T3时点MAP和T1～ T5时点心率均高于T0时点[(89±8)、(83±8)、(82±7)mmHg(1mmHg=0.133 kPa)比(77±6)mmHg,(88 ± 10)、(87±9)、(86±9)、(85±8)、(83±8)次/min比(79±7)次/min],B组患者T1、T2时点MAP[(79±7)、(78 ±7) mmHg]和T1～T5时点心率[(80±8)、(79±8)、(79±8)、(77±7)、(77±7)次/min]均低于A组同时点,C组T1、T2、T3时点MAP[(78 ±7)、(77±8)、(76±7) mmHg]均低于A组同时点,T1～T5时点心率[(70±8)、(69±7)、(71±7)、(71±7)、(72±7)次/min]均低于T0时点[(79±8)次/min]和A、B组同时点,差异均有统计学意义(均P＜0.05).3组患者各时点呼吸频率比较差异均无统计学意义(均P＞0.05).B、C组患者T1、T2、T3时点的VAS评分及Ramsay镇静评分均低于A组[VAS评分:(2.8±0.5)、(2.3±0.5)分比(3.5±0.7)分,(2.9±0.6)、(2.4±0.5)分比(3.6±0.7)分,(2.4±0.5)、(2.0±0.4)分比(2.7±0.6)分;Ramsay镇静评分:(2.43±0.43)、(1.63±0.29)分比(3.22±0.51)分,(2.22±0.28)、(1.54±0.42)分比(2.82±0.44)分,(2.02±0.33)、(1.48±0.32)分比(2.41±0.50)分],且C组均明显低于B组,差异均有统计学意义(均P ＜0.05);3组患者术后T4、T5时点的VAS评分及Ramsay镇静评分比较,差异无统计学意义(P＞0.05).3组患者术中舒芬太尼、瑞芬太尼和术后使用补救镇痛药物患者例数比较,差异均无统计学意义(均P ＞0.05).B组和C组患者术后48 h内自控镇痛平均按压次数、不良反应发生率明显低于A组[(20.4±2.2)、(14.9±1.2)次比(26.6±4.2)次,25.0％ (10/40)、12.5％ (5/40)比42.5％ (17/40)],差异均有统计学意义(均P ＜0.05).结论 氟比洛芬酯联合右美托咪定对食管癌根治术患者的术后镇痛效果较好,且不良反应较少,安全性较高.%Objective To explore the analgesic effect of dexmedetomidine combined with flurbiprofen in patient controlled analgesia (PCA) after radical resection of esophageal cancer.Methods One hundred and twenty patients undergoing radical resection of esophageal cancer were randomly divided into group A,B and C (40 cases in each group).In group A,50 mg flurbiprofen was given 30 min before the end of operation,2.5 μg/kg sufentanil +2 mg tropisetron added in 0.9％ sodium chloride was given in PCA;in group B,50 mg flurbiprofen was given 30 min before the end of operation,2.0 μg/kg sufentanil + 150 mg flurbiprofen + 2 mg tropisetron added in 0.9％ sodium chloride was given in PCA;in group C 50 mg flurbiprofen was given 30 min before the end of operation,1.5 μg/kg sufentanil + 150 mg flurbiprofen + 2.0 μg/kg dexmedetomidine + 2 mg tropisetron added in 0.9％ sodium chloride was given in PCA.The PCA pumps were adjusted as a standard of 100 ml volume,continuous perfusion rate of 2 ml/h,single bolus of 2 ml and lockout time of 15 min.The heart rate (HR),mean artery blood pressure (MAP),oxygen saturation (SpO2),respiratory rate (RR),visual analog scale (VAS) and Ramsay sedation score were recorded before operations (T0),2 h (T1),4 h (T2),8 h (T3),24 h (T4),48 h (T5) after operation;the usages of intraoperative analgesic drugs (including sufentanila and ruifentanyl) and postoperative remedial analgesia drugs were recorded;the pressing times of PCA pump and adverse reactions within 48 h after operation were compared among groups.Results The MAP at T1-T3,the HR at T1-T5 were significantly higher than those at T0 in group A [(89 ± 8),(83 ± 8),(82 ± 7) mmHg vs (77 ± 6) nunHg,(88 ± 10),(87 ±9),(86 ±9),(85 ±8),(83 ±8) times/min vs (79 ±7) times/min] (all P＜0.05);in group B,the MAP at T1-T2 [(79 ± 7),(78 ± 7) mmHg],the HR at T1-T5 [(80 ± 8),(79 ± 8),(79 ± 8),(77 ± 7),(77 ± 7) times/min] were all significantly lower than those in group A at the same time point (all P ＜ 0.05);in group C,the MAP at T1-T3[(78 ±7),(77 ±8),(76 ±7) mmHg] were significantly lower than those in group A at the same time point,the HR at T1-T5[(70 ±8),(69±7),(71 ±7),(71 ±7),(72±7) times/min] were significantly lower than those at T0[(79 ±8) times/min] (all P ＜ 0.05) and those in group A and B at the same time points (all P ＜ 0.05).The RR at each time point after surgery had no significantly differences among groups (P ＞ 0.05).The VAS scores and Ramsay sedation scores in group B and C were significantly lower than those in group A at T1-T3 [VAS scores:(2.8 ±0.5),(2.3 ±0.5) scores vs (3.5 ±0.7) scores;(2.9 ±0.6),(2.4 ± 0.5) scores vs (3.6 ± 0.7) scores;(2.4 ± 0.5),(2.0 ± 0.4) scores vs (2.7 ± 0.6) scores;Ramsay sedation scores:(2.43 ± 0.43),(1.63 ± 0.29) scores vs (3.22 ± 0.51) scores;(2.22 ± 0.28),(1.54 ± 0.42) scores vs (2.82 ± 0.44) scores;(2.02 ± 0.33),(1.48 ± 0.32) scores vs (2.41 ± 0.50) scores],in addition,they were significantly lower in group C than those in group B (all P ＜ 0.05);the VAS scores and Ramsay sedation scores at T4 and T5 were not significantly different among groups (all P ＞ 0.05).The usages of intraoperative analgesic drugs and postoperative remedial analgesia drugs were not significantly different among groups.The pressing time of PCA in group B and C were significantly lower than that in group A within 48 h after operation [(20.4 ±2.2),(14.9 ± 1.2) times vs (26.6±4.2) times],and was significantly less in group C than that in group B (all P ＜ 0.05).The incidence of adverse reactions in group B and C were significantly lower than that in group A [25.0％ (10/40),12.5 ％ (5/40) vs 42.5％ (17/40)] (P ＜ 0.05),but there was no significant difference between group B and C (both P ＞ 0.05).Conclusion Flurbiprofen combined with dexmedetomidine has good analgesic effect after radical resection of esophageal cancer,with less adverse reaction and higher safety.
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