文章摘要

右美托咪定持续硬膜外给药用于胸腔镜肺癌根治术后镇痛的临床观察

作者: 1陈伟, 1陈斌, 1胡北, 2齐敦益
1 徐州医科大学附属宿迁医院麻醉科,江苏 宿迁 223800
2 徐州医科大学附属医院麻醉科,江苏 徐州 221000
通讯: 齐敦益 Email: 2496341755@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.12.014

摘要

目的:观察右美托咪定(dexmedetomidine,DEX)持续硬膜外给药用于胸腔镜肺癌根治术后镇痛的效果。方法:选取60例美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级I~II级择期行胸腔镜肺叶切除术的肺癌患者,术后采用硬膜外自控镇痛(patient controlled epidural analgesia,PCEA),根据使用镇痛药物的不同,随机均分成D组(DEX 1.0 μg/kg+罗哌卡因250 mg+0.9%生理盐水至250 mL)、S组(舒芬太尼1.0 μg/kg+罗哌卡因250 mg+0.9%生理盐水至250 mL)和R组(罗哌卡因250 mg+0.9%生理盐水至250 mL),观察并记录术后4 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)各时点的视觉模拟评分(visual analogue scale,VAS)与Ramsay镇静评分,记录术后镇痛相关不良反应如低血压、心动过缓、呼吸抑制、恶心呕吐、皮肤瘙痒、咳痰无力及嗜睡等发生情况,并比较各组术后PCEA有效按压总次数及术后镇痛综合满意度。结果:D组、S组各时点VAS评分明显低于R组,差异有统计学意义(P<0.05)。3组患者术后各时点VAS评分均小于4分,无患者使用镇痛补救药物;3组患者术后PCEA有效按压总次数差异无统计学意义(P>0.05)。D组Ramsay评分各时点明显高于R组和S组,差异有统计学意义(P<0.05)。D组、S组、R组的不良反应分别是1例、7例、5例,D组不良反应发生率最低,差异有统计学意义(P<0.05)。术后镇痛效果综合评价,D组满意度明显高于R组和S组,差异有统计学意义(P<0.05)。结论:DEX持续硬膜外给药用于胸腔镜肺癌根治术后镇痛效果佳,不良反应少,能够为此类患者术后提供安全满意的镇痛效果。
关键词: 右美托咪定;硬膜外给药;肺癌;胸腔镜;术后镇痛

Clinical observation of dexmedetomidine continuous epidural analgesia for thoracic lung cancer after radical operation

Authors: 1CHEN Wei, 1CHEN Bin, 1HU Bei, 2QI Dunyi
1 Department of Anesthesiology, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian Jiangsu 223800, China
2 Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu 221000, China

CorrespondingAuthor: QI Dunyi Email: 2496341755@qq.com

Abstract

Objective: To observe the effect of continuous epidural administration of dexmedetomidine for analgesia after thoracoscopic lung cancer radical operation. Methods: Sixty patients with American Society of Anesthesiologists (ASA) I–II grade elective lung cancer after thoracoscopic lobectomy underwent postoperative epidural analgesia (patient controlled epidural analgesia, PCEA), and were randomly divided into group D according to different analgesic drugs (dexmedetomidine 1.0 μg/kg + ropivacaine 250 mg + 0.9% saline to 250 mL), group S (sufentanil 1.0 μg/kg + ropivacaine 250 mg + 0.9% saline to 250 mL) and group R (simple ropivacaine 250 mg + 0.9% saline to 250 mL). Observe and record the visual analogue scale score and Ramsay score at each time point of 4 h (T1), 12 h (T2), 24 h (T3), and 48 h (T4) after operation, and record the postoperative pain-related adverse reactions such as hypotension, bradycardia, respiratory depression, nausea and vomiting, skin itching, sputum weakness and lethargy occurred, and the total number of effective postoperative PCEA compressions and the overall satisfaction of postoperative analgesia were compared in each group. Results: The VAS scores of groups D and S at each time point were significantly lower than those of group R, and the differences were statistically significant (P<0.05). The VAS scores of the three groups of patients were less than 4 points at all time points, and no patient used analgesic remedies; there was no significant difference in the total number of effective PECA compressions in the three groups of patients (P>0.05). The Ramsay score of group D was significantly higher than that of group R and S at each time point, and the differences were statistically significant (P<0.05). The adverse reaction in groups D, S, and R were 1, 7 and 5 cases, respectively. The incidence of adverse reactions was the lowest in group D, and the difference was statistically significant (P<0.05). After comprehensive evaluation of postoperative analgesic effect, the satisfaction of group D was significantly higher than that of group R and S, and the difference was statistically significant (P<0.05). Conclusion: Dexmedetomidine continuous epidural administration has good analgesic effects after thoracoscopic lung cancer radical operation, with few adverse reactions, and can provide a safe and satisfactory analgesic effect for such patients.
Keywords: dexmedetomidine; epidural administration; lung cancer; thoracoscopy; postoperative analgesia