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| 右美托咪定或丙泊酚复合芬太尼用于晚期癌痛植入式鞘内药物输注系统植入手术的比较 |
| Comparison of dexmedetomidine and propofol combined with fentanyl for IDDS implantation in patients with advanced cancer pain |
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| DOI：10.12089/jca.2019.08.005 |
| 中文关键词: 右美托咪定 丙泊酚 晚期癌痛 镇静 鞘内药物输注系统 |
| 英文关键词: Dexmedetomidine Propofol Advanced cancer pain Sedation Intrathecal drug infusion system |
| 基金项目: |
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| 中文摘要: |
目的 比较右美托咪定或丙泊酚复合芬太尼用于晚期癌痛鞘内药物输注系统植入手术的有效性及安全性。
方法 选择晚期癌痛行鞘内药物输注系统手术的患者40例，男31例，女9例，年龄48~78岁，ASA Ⅱ或Ⅲ级，采用随机数字表法分为两组：右美托咪定复合芬太尼组(D组)和丙泊酚复合芬太尼组（P组），每组20例。D组于术前10 min内静脉泵入右美托咪定0.5 μg/kg，继以0.2~0.5 μg·kg-1·h-1持续泵注至术毕，以维持患者Ramsay评分3~4分。P组于术前10 min内共静脉泵注丙泊酚2 mg/kg，后以1.5 mg·kg-1·h-1持续泵注丙泊酚并适当增减维持剂量，以维持患者Ramsay评分3~4分至术毕。两组患者于术前5 min均静注芬太尼1 μg/kg，并间断追加芬太尼。记录入室时(T0)、手术开始时(T1)、手术开始后30 min(T2)、60 min(T3)、90 min(T4)、术毕(T5)、入PACU后30 min(T6)的MAP、HR、SpO2和VAS评分;记录呼吸循环干预情况，恶心呕吐等并发症的发生情况;记录芬太尼用量、手术时间、患者完全恢复时间、患者满意度评分等。
结果 与T0时比较，T1—T6时两组MAP、VAS评分明显降低，HR明显减慢(P<0.05)，T1—T5时P组SpO2明显降低，T1时D组SpO2明显降低(P<0.05)。与P组比较，D组T2—T5时HR明显减慢，VAS评分明显降低，而T1—T5时SpO2明显升高(P<0.05)，且芬太尼用量明显减少，低血压发生率明显降低(P<0.05)。
结论 与丙泊酚复合芬太尼比较，右美托咪定复合芬太尼用于晚期癌痛患者鞘内药物输注系统手术镇痛效果更完善，且对呼吸影响较小，并可减少芬太尼的用量及低血压的发生率。 |
| 英文摘要: |
Objective To compare the feasibility and safety of dexmedetomidine or propofol combined with fentanyl in sedation and analgesia during implantation of intrathecal drug infusion system (IDDS) for patients with advanced cancer pain.
Methods Forty patients scheduled for IDDS implantation surgery with advanced cancer pain, 31 males and 9 females, aged 48-78 years, ASA physical status Ⅱ-Ⅲ were randomly assigned to two groups: dexmedetomidine combined with fentanyl group (group D, n = 20) and propofol combined with fentanyl group (group P, n = 20). In group D, patients were infused with dexmedetomidine at a loading dose of 0.5 μg/kg within 10min before operation, followed by a maintenance infusion of 0.2-0.5 μg·kg-1·h-1 to maintain the patient's Ramsay score by 3-4 points until the end of surgery. In group P, patients were infused with propofol at a loading dose of 2 mg/kg within 10 min before operation, followed by 1.5 mg·kg-1·h-1 continuous infusion and modulated the dose to maintain the patient's Ramsay score by 3-4 points until the end of surgery. All patients received 1 μg/kg fentanyl intravenously 5 min before operation. During the operation, fentanyl was intermittently injected according to patient′s VAS scores. The patient's MAP, HR, SpO2 and VAS scores were measured and recorded for this study at after entering operation room (T0), the beginning of operation (T1), operation for 30 min, 60 min and 90 min (T2 -T4), the end of operation (T5) and 30 min after arrival at PACU (T6), and the interventions of respiratory and circulatory system were recorded in both groups. The incidences of side effects (such as nausea and vomiting), fentanyl consumption, time to full recovery and patient satisfaction scores were also recorded.
Results Compared to T0, the levels of MAP, HR, VAS scores were significantly lower in both groups at T1-T5 (P<0.05), whereas SpO2 were significantly lower in group P at T1-T5, and were significantly lower in group D at T1 (P < 0.05). Compared to those at group P, the HR and VAS were lower at T2 -T5, the SpO2 were higher at T1 -T5, and patients acquired less fentanyl consumption and the incidence of hypotension in group D (P < 0.05).
Conclusion Compared with group P, dexmedetomidine combined with fentanyl used in patients with advanced cancer pain for IDDS implantation surgery can achieve better analgesic effect, smaller influence of breathing, less fentanyl consumption and the incidence of hypotension. |
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