右美托咪定对电视辅助胸腔镜手术肺叶切除后镇痛效果的影响

Effect of dexmedetomidine on postoperative analgesia in patients undergoing video assisted thoracoscopic lobectomy

关键词:  右美托咪定  胸腔镜  肺叶切除术  术后镇痛

Key words:  dexmedetomidine  thoracoscopy  lobectomy  postoperative analgesia

摘要:

目的 观察右美托咪定对胸腔镜下肺叶切除患者术后镇痛的影响。方法 选取83例在电视辅助胸腔镜下行单侧肺叶切除术患者，根据麻醉药物不同随机分2组： 舒芬太尼组(S组,n=42)、右美托咪定复合舒芬太尼组（SY组，n=41）。两组患者均以雷米芬太尼4~5μg/(kg·h)和2%~4%七氟醚维持麻醉，罗库溴铵按时按需追加。SY组麻醉诱导后，右美托咪定0.01μg/(kg·min)微泵注射，右美托咪定不给予负荷剂量，直接持续泵维持至手术结束。术后镇痛泵配方： SY组在S组基础上加200μg右美托咪定同时减少50μg舒芬太尼。采用静息时镇痛评分（visual analgesic score at rest, VASR）、咳嗽时镇痛评分（visual analgesic score in coughing, VASC）、Ramsay镇静评分分别评价两组术后4（T1）、8（T2）、12（T3）、24（T4）、48h（T5）疼痛及镇静程度，同时记录术后48h内自控镇痛按压次数、患者术后住院天数及不良事件发生率。结果 术后T1~T4各时点，VASR、VASC差异有统计学意义（P<0.05），T5时点VASC差异有统计学意义（P<0.05）;术后48h，除T4时点外，患者自控镇痛平均有效按压次数差异有统计学意义（P<0.05），术后48h内（心率改变、血压异常改变以及恶心呕吐、呼吸抑制、肺不张、肺部感染、术后住院天数）发生率差异均有统计学意义（P<0.05）。结论 右美托咪定可增强电视辅助胸腔镜手术肺叶切除后镇痛效果，减少术后肺部并发症，促进患者术后康复。

Abstract:

Objective To determine the effects of dexmedetomidine on postoperative analgesia in patients undergoing video-assisted thoracoscopic (VATS) lobectomy. Methods Eighty-three patients of ASA grade Ⅰ-Ⅲ undergoing VATS unilateral lobectomy were randomly assigned into two groups： sufentanil group (group S, n=42) and dexmedetomidine combined with sufentanil group (group SY, n=41). Two groups received the same rapid intravenous anesthesia induction program, maintaining with remifentanil 4-5 μg/(kg·h) and 2%-4% sevoflurane, rocuronium was added on time and on demand. At the same time, dexmedetomidine hydrochloride 0.01 μg/(kg·min) was injected with micropump after the induction of anesthesia in group SY. dexmedetomidine did not give a load dose direct continuous pump to the end of the operation. In group SY 200μg dexmedetomidine was added to postoperative patient-controlled analgesia (PCA) infusion pump on the basis of group S and sulfentanyl was reduced by 50μg simultaneously. The VAS pain scores and Ramsay sedation score were applied for evaluation at 4（T1）, 8（T2）, 12（T3）, 24（T4） and 48h（T5）after surgery. The times of PCA pump use within 48 h after surgery and the incidence of adverse events were documented. Results There were significant differences in VASR and VASC at all time points except T5 of VASR after operation between two groups (P<0.05). There was significant difference in the effective PCA pump press times at time points T1, T2 and T3 after operation (P<0.05). There were significant differences in the incidence of postoperative complications including heart rate changes, abnormal blood pressure changes, nausea and vomiting, respiratory depression, atelectasis, pulmonary infection, and as well as postoperative hospitalization days between two groups (P<0.05). Conclusion Dexmedetomidine can enhance the analgesic effect, reduce the side effects of sufentanil, reduce postoperative pulmonary complications and promote postoperative recovery for patients undergoing VATS pulmonary lobectomy.