麻醉诱导前应用右美托咪定对老年腹部肿瘤手术患者术后镇痛和镇静效果的影响

摘要

目的 评估麻醉诱导前应用右美托咪定对老年腹部肿瘤手术患者术后镇痛和镇静效果的影响.方法 以行腹部肿瘤手术老年患者120例为研究对象,随机分为观察组(60例)和对照组(60例).观察组患者在麻醉诱导前给予静脉泵注右美托咪定,对照组患者麻醉诱导前静脉泵注生理盐水.比较两组患者术后3、6、12、24、48 h各时间点的视觉模拟评分(VAS)、Ramsay镇静评分,比较两组患者术后48 h自控镇痛泵的使用次数和不良反应情况.结果 观察组术后6、12、24、48 h的VAS评分分别为(4.33±0.91)、(3.06±0.66)、(2.39±0.61)和(2.30±0.60),均明显低于对照组(P<0.05).观察组术后12、24、48 h的Ramsay评分分别为(0.90±0.36)、(0.91±0.39)和(0.86±0.36),均明显低于对照组(P<0.05).观察组术后48 h的自控镇痛泵的使用次数为(1.91±0.81),对照为(5.81±1.33),两组间差异显著(P<0.05).观察组的不良反应发生率明显低于对照组(10.0% vs.26.7%)(P<0.05).结论 麻醉诱导前应用右美托咪定能明显改善老年腹部肿瘤手术患者的术后疼痛,起到较好的镇静作用,且不良反应少.%Objective To evaluate the effect of pretreated dexmedetomidine on postoperative analgesia and sedation in elderly patients who underwent abdominal surgery.Methods A total of 120 elderly patients with abdominal surgery were enrolled.All the patients were randomly divided into the observation and the control groups with 60 cases in each group.The patients in the observation group were given intravenous infusion of dexmedetomidine before induction of anesthesia, and patients in the control group received intravenous infusion of saline before induction of anesthesia.The visual analog scale (VAS) and Ramsay sedation score at different time points (3, 6, 12, 24 and 48 h postoperatively), the frequency of usage of self-controlled analgesia pump 48 h post-operation, and the adverse events in both groups were recorded and compared.Results In the observation group, VAS scores at 6 h, 12 h, 24 h and 48 h postoperatively were (4.33 ± 0.91), (3.06 ± 0.66), (2.39 ± 0.61) and (2.30 ± 0.60), respectively, which were significantly lower than those of the control group(P<0.05).Ramsay scores at 12, 24 and 48 h postoperatively in the observation group were (0.90 ± 0.36), (0.91 ± 0.39) and (0.86 ± 0.36), respectively, which were significantly lower than those of the control group(P<0.05).In the observation group, the frequency of the usage of self-controlled analgesia pump was (1.91 ± 0.81), which was significantly lower than that of the control group (5.81±1.33)(P<0.05).The incidence of adverse reactions in the observation group was significantly lower than that of the control group (10.0%, vs.26.7%, P<0.05).Conclusions The application of dexmedetomidine prior to the induction of anesthesia could significantly relieve postoperative pain with better sedation and less adverse events in the elderly patients who underwent abdominal surgery.