联合应用右美托咪定和舒芬太尼对尼古丁高依赖患者食管癌术后镇痛效果的影响

摘要

目的: 探讨联合应用右美托咪定和舒芬太尼对尼古丁高依赖患者食管癌术后镇痛效果的影响.方法:选择经左胸一切口食管癌切除术尼古丁高依赖男性患者90例,随机均分为低剂量舒芬太尼组(S1组)、高剂量舒芬太尼组(S2组)和右美托咪定联合舒芬太尼组(DS组). 3组患者术后PCIA泵设置均为:背景剂量:2 mL/h;单次剂量:2 mL;锁定时间:5 min;4 h限量:40 mL. 分别于术后1、4、8、12、24、48、72 h行VAS评分、Ramsay镇静评分、PCIA有效按压/总按压次数和术后72 h舒芬太尼消耗量. 观察术后不良反应和患者满意度.结果:与S2组比较,DS组术后1、4、8 h静息和咳嗽 VAS评分明显降低(P < 0.05).与S1组比较,S2组和DS组术后各时间点静息和咳嗽 VAS评分明显降低(P < 0.05). 与S1和S2组比较,DS组术后72 h舒芬太尼消耗量明显降低(P < 0.05). 与DS组相比,S1组和S2组术后恶心、呕吐发生率显著减少(P < 0.05). 与S1组相比,S2组和DS组患者术后补救例数明显降低(P < 0.05). 结论:对尼古丁高依赖男性患者食管癌术后的镇痛,联合应用右美托咪定和舒芬太尼的效果优于单纯应用舒芬太尼,且并发症减少,可以安全有效的应用于临床.%Objective To observe the effect of combination of dexmedetomidine and sufentanil on postoperative analgesia for the highly nicotine dependent patients undergoing esophagectomy. Methods Ninety highly nicotine dependent patients undergoing esophagectomy were randomly allocated into three groups (n = 30 each): low-dose sufentanil group (Group S1), high-dose sufentanil (Group S2), dexmedetomidine and sufentanil group (Group DS). All patients of three groups received postoperative PCIA with following setting: 2 mL/h;bolus: 2 mL; lock time: 5 min; 4 hours limited: 40 mL. The scores of VAS and Ramsay, effective presses/total presses of PCIA, the consumption of sufentanil during 72 h after operation, side effects and the satisfaction degree of patients were recorded. Results Compared with those of group S2, the scores of VAS (both at rest and movement) decreased significantly in group DS from 1 h to 8 h (P<0.05). Compared with those of group S1, the scores of VAS (both at rest and movement) decreased significantly in group S2 and DS from 1 h to 72 h (P<0.05). Compared with that in group S1 and S2, the consumption of sufentanil during 72 h after operation decreased significantly in group DS (P < 0.05). Compared with those in group DS, The numbers of nausea and vomiting were significant decreased in group S1 and S2(P < 0.05). Compared with those in group S1, the remedial cases were significantly decreased in group S2 and group DS (P < 0.05). Conclusion The effect of combination of dexmedetomidine and sufentanil is superior to that of sufentanil in terms of postoperative analgesia in highly nicotine dependent male patients undergoing esophagectomy.