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| 舒芬太尼复合右美托咪定用于喉部分切除术后患者自控静脉镇痛的效果 |
| Effect of sufentanil combined with dexmedetomidine on patient-controlled intravenous analgesia after partial laryngectomy |
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| DOI：10.12089/jca.2021.02.007 |
| 中文关键词: 舒芬太尼 右美托咪定 喉部分切除 患者自控静脉镇痛 |
| 英文关键词: Sufentanil Dexmedetomidine Partial laryngectomy Patient-controlled intravenous analgesia |
| 基金项目:陕西省重点研发计划项目（2019KW-066） |
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| 中文摘要: |
目的 观察舒芬太尼复合右美托咪定用于喉部分切除术后患者自控静脉镇痛（PCIA）的效果。
方法 选择全麻下行喉部分切除术患者60例，男44例，女16例，年龄35～65岁，ASA Ⅰ或Ⅱ级。采用随机数字表法分为两组：舒芬太尼组（S组）和舒芬太尼复合右美托咪定组（SD组），每组30例。术毕行PCIA，S组配方为舒芬太尼1.5 μg/kg；SD组配方为舒芬太尼1.5 μg/kg+右美托咪定5 μg/kg，两组均用生理盐水配成100 ml，背景输注速度2 ml/h，单次剂量1 ml，锁定时间15 min。记录术后4、8、12、24 h的VAS疼痛评分、Ramsay镇静评分、术后24 h内舒芬太尼用量、补救镇痛例数、咳嗽次数、吸痰次数及吸痰时躁动数、睡眠时间以及术后PCIA期间切口出血、心动过缓、肺部感染、呼吸抑制等不良反应。
结果 两组术后不同点VAS疼痛评分均≤4分。与S组比较，SD组术后不同时点VAS疼痛评分明显降低，Ramsay镇静评分明显升高，术后24 h内舒芬太尼用量明显减少，咳嗽发生次数及吸痰时躁动明显减少，术后当日睡眠时间明显延长（P<0.05）。两组术后切口出血及肺部感染发生率差异无统计学意义。两组均无补救镇痛，未见心动过缓、呼吸抑制发生。
结论 舒芬太尼复合右美托咪定PCIA用于喉部分切除术后镇痛效果确切，且能明显减轻患者气道反应，减少舒芬太尼用量，减少术后刺激性咳嗽次数，降低吸痰时躁动发生，有利于患者恢复。 |
| 英文摘要: |
Objective To observe the efficacy of sufentanil combined with dexmedetomidine for patient-controlled intravenous analgesia (PCIA) after partial laryngectomy.
Methods Sixty patients scheduled for partial laryngectomy under general anesthesia, 44 males and 16 females, aged 35-65 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups using a random number table: control group (group S) and experimental group (group SD), 30 patients in each group. PCIA was performed at the end of the operation. The analgesic pump formula in group S was sufentanil 1.5 μg/kg; the analgesic pump formula in group SD was sufentanil 1.5 μg/kg + dexmedetomidine 5 μg/kg, and both groups were mixed with normal saline to make 100 ml, background infusion rate 2 ml/h, bolus 1 ml, lock time 15 minutes. The VAS pain score, Ramsay sedation score, the amount of sufentanil within 24 hours after surgery, the number of remedial analgesia, the number of coughs, the number of suctions, and the times of restlessness during suction 4, 8, 12, and 24 hours after surgery were recorded. Sleep time and adverse reactions such as incision bleeding, bradycardia, lung infection and respiratory depression during postoperative PCIA were also recorded.
Results The VAS pain score in group SD was significantly lower than that in group S at different time points after operation, Ramsay's sedation score was significantly higher than that in group S, the amount of sufentanil within 24 hours after surgery was significantly less than that in group S, and the times of coughs and agitation during suction were obvious less than that in group C, sleep time on the day after surgery was significantly longer than that in group S (P < 0.05). There was no significant difference in the incidence of postoperative incision bleeding and lung infection between the two groups. There was no remedial analgesia in both groups, and no bradycardia or respiratory depression occurred.
Conclusion Sufentanil combined with dexmedetomidine for PCIA after partial laryngectomy has better efficacy, it can significantly reduce the airway reactivity, spare the use of sufentanil, cut down the number of postoperative irritant coughs and decrease the incidence of agitation during sputum suction, which is helpful to the recovery of the patients. |
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