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术中应用右美托咪定对上腹部手术术后吗啡镇痛效果的影响
The postoperative effect of Dexmedetomidine used during the surgery on the analgesic efficacy
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DOI:
作者:
单嘉琪,江伟,缪长虹,张燕影
SHAN Jia-qi, JIANG Wei, MIAO Chang-hong, ZHANG Yan-ying
作者单位:
上海市第六人民医院麻醉科 上海市第六人民医院麻醉科 复旦大学附属肿瘤医院麻醉科 复旦大学附属中山医院麻醉科
Department of Anesthesiology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University Department of Anesthesiology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University Department of Anesthesiology, Fudan University Shanghai Cancer Center Department of Anesthesiology, Zhongshan Hospital Fudan University
关键词:
右美托咪定;吗啡;镇痛效果
Dexmedetomidine; Morphine; Analgesic Efficacy
摘要:
目的 观察术中应用右美托咪定对于胃大部切除术患者术后静脉吗啡自控式镇痛(PCIA)效果的影响。方法 拟行胃大部切除术患者30例,ASA I或II级,随机均分为两组:右美托咪定组(D组)和生理盐水组(C组)。麻醉诱导后D组于手术划皮前静脉泵注右美托咪定0.5ug/kg,10分钟内输注完毕后术中以0.2ug•kg-1•h-1维持,至手术结束前30分钟停药。C组注射等容量生理盐水。所有患者术后均行吗啡自控式镇痛。记录两组患者术后第1、4、8、12、24小时的VAS评分,术后第一次追加镇痛药物的时间,术后24小时吗啡总消耗量以及术后不良反应的发生情况。结果 D组在术后第1、4、8、12小时的VAS评分均明显小于C组(P<0.05),D组术后第一次追加镇痛药物的时间明显迟于C组(P<0.05),D组术后24小时吗啡总消耗量明显少于C组(P<0.05)。D组术后恶心呕吐发生率低于C组,但两组差异无统计学意义。结论 患者术中应用右美托咪定可显著提高术后静脉吗啡的镇痛效果,减少阿片类药物用量。
Objective To observe the postoperative effect of Dexmedetomindine used in the surgery on the analgesic efficacy of patient-controlled intravenous analgesia (PCIA) with morphine. Methods Thirty ASA I or II patients undergoing gastrogastosomy were randomly divided into two groups (n=15 each): Dexmedetomidine group (group D) and normal saline group (group C). After induction of anesthesia group D was injected with Dexmedetomidine 0.5ug/kg in ten minutes and then maintain the injection rate at 0.2ug•kg-1•h-1 untill 30 minutes before the end of the surgery. Group C was injected with an equal volume of normal saline. After the operation, the PCIA with morphine was started and recorded. The analgesic efficacy was observed, including VAS, morphine consumption, the adverse reaction of morphine (nausea, vomiting, itching) at the time point of 1hr, 4hr, 8hr, 12hr, 24hr. Results The VAS scores in group D were significantly lower than group C at 1hr, 4hr, 8hr, 12hr. Its morphine consumption was significantly lower than group C. The occurrence of postoperative nausea and vomiting was lower in group D than in group C, but did not have statistical difference. Conclusion Dexmedetomidine used during the surgery can enhance the postoperative analgesic efficacy, decrease the comsuption of morphine.
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