右美托咪定对颅脑损伤患者术后镇痛效果的影响

Influence of dexmedetomidine on postoperative analgesia in patients with craniocerebral injury

关键词:  右美托咪定  颅脑损伤  镇痛  镇静

Key words:  dexmedetomidine  craniocerebral injury  analgesia  sedative

摘要:

目的　观察右美托咪定对颅脑损伤患者术后血流动力学及镇痛镇静效果的影响。方法　选取2016年1—12月60例颅脑损伤手术患者，ASA Ⅰ~Ⅱ级，随机数字表法分成对照组及观察组，对照组30例给予常规的麻醉诱导方案；观察组30例在麻醉诱导前静脉泵入右美托咪定1 μg/kg，10 min泵注预定计量后改为0.5 μg/（kg·h）静脉持续泵入，直至术后24 h。两组患者术后均使用自控静脉镇痛（PCIA）药物舒芬太尼。记录两组患者术后2 h（T1）、4 h（T2）、8 h（T3）、12 h（T4）、24 h（T5）各时点的血液动力学变化、视觉模拟评分（VAS）、拉姆齐镇静评分（RSS）、PCIA舒芬太尼的总消耗量；术后患者PCIA的有效按压次数及药物相关不良反应发生率。结果　与对照组比较，观察组T1-T4的HR、MAP均明显降低，T1-T5的VAS评分也明显降低，在T1时刻，RSS镇静评分两组有显著差异，术后T1、T2和T3时刻PCIA有效按压次数减少，T1-T2舒芬太尼累计用量明显减少，同时呕吐、恶心发生率也明显降低，两组比较差异均有统计学意义（P<0.05）。结论　颅脑损伤患者在泵注右美托咪定后不仅能维持患者稳定的血流动力学、有效减轻其术后疼痛，还可显著降低舒芬太尼术后用量，且不良反应发生率较低。

Abstract:

ObjectiveTo investigate the effect of dexmedetomidine on postoperative hemodynamics and analgesic sedative effect in patients with craniocerebral injury.MethodsSixty patients with craniocerebral injury from January to December in 2016, ASA I-II, were randomly divided into two groups: control group (n=30) and observation group (n=30). In the control group, patients were given routine anesthetic induction scheme. In the observation group, patients were given intravenous infusion of dexmedetomidine 1 μg/kg before induction of anesthesia and continuous intravenous pump of 0.5 μg / ( kg · h ) at 10 min after infusion until 24 hours after operation. The two groups of patients were treated with self controlled intravenous analgesia (PCIA) by sufentanil. The patients were monitored after 2 h (T1), 4 h (T2), 8 h (T3), 12 h (T4), and 24 h (T5). Hemodynamic changes, visual analogue scale (VAS), Ramsay (RSS), sedation score, and total PCIA consumption of sufentanil were recorded at each time point. The incidence of postoperative PCIA effective compressions and drug related adverse reactions were compared.ResultsCompared with the control group, the HR、MAP of T1-T4 in the observation group were significantly lower than those in the control group. The VAS score of T1-T5 was also significantly reduced. At T1, there were significant differences between the two groups in RSS sedation scores, the effective press times of PCIA decreased at T1, T2 and T3 postoperatively. T1-T2 had significantly reduced the amount of sufentanil. At the same time, the incidence of vomiting and nausea also decreased significantly. The difference between the two groups was statistically significant (P<0.05).ConclusionInfusion of dexmedetomidine in patients with craniocerebral injury not only can maintain hemodynamics and effectively reduce postoperative pain, but also can significantly reduce the postoperative sufentanil consumption and low incidence rate of adverse reaction.