右美托咪定对舒芬太尼术后自控镇痛疗效和全身炎症反应的影响-现代医学

右美托咪定对舒芬太尼术后自控镇痛疗效和全身炎症反应的影响

单位：1. 陕西省结核病防治院麻醉科, 陕西西安 710100;
2. 安康市中医医院麻醉科, 陕西安康 725000

分类号：R614

出版年·卷·期（页码）：2017·36·第八期（1095-1099）

摘要：

目的：探讨右美托咪定对舒芬太尼术后自控镇痛疗效和全身炎症反应的影响。方法：择期行全麻开胸手术患者160例，随机分为四组，分别为高剂（1.5 μg·kg^-1+100 μg舒芬太尼+托烷司琼4 mg，H组）、中剂（1 μg·kg^-1+100 μg舒芬太尼+托烷司琼4 mg，M组）、低剂（0.5 μg·kg^-1+100μg舒芬太尼+托烷司琼4 mg，L组）及单纯（150 μg舒芬太尼+托烷司琼4 mg，C组）。观察患者术后T₁（0.5 h）、T₂（2 h）、T₃（6 h）、T₄（12 h）、T₅（24 h）的VAS评分、RAMSAY评分，检测患者血样中反应蛋白（CRP）、TNF-a和IL-10的水平并记录48 h内不良反应情况。结果：与C组患者相比，H组T_2-5时点VAS评分显著降低，M组T_3-5时点VAS评分显著降低，L组T_3-4时点VAS评分显著降低；与C组相比，L组T_3-4时点，M组T_3-5时点及H组T_2-5时点的Ramsay评分均明显升高；但与C组相比，三组观察组患者T_2-4时点CRP、TNF-α水平出现明显降低，IL-10水平出现明显升高，差异均有统计学意义；并且H组术后不良反应率为52.5%，C组为47.5%，两者明显高于M组的12.5%与L组的10%，差异具有统计学意义。结论：复合右美托咪定在开胸手术患者术后舒芬太尼自控静脉镇痛中临床效果显著，右美托咪定剂量越高镇痛起效越快，但适当减少剂量可保证不良反应减少的同时确保镇痛效果，右美托咪啶1 μg·kg^-1为比较理想的使用剂量。

Objective: To explore the effects of dexmedetomidine on controlled analgesic efficacy and systemic inflammatory response in sufentanil after operation.Methods: 160 patients who would have thoracotomy were selected and divided into four groups:high dose group(1.5ug/kg dexmedetomidine+100 ugsufentanil+4 mg tropisetron,H), moderate dose group(1ug/kg dexmedetomidine+100 ugsufentanil+4 mg tropisetron,M), low dose group(0.5ug/kg dexmedetomidine+100 ugsufentanil+4 mg tropisetron,L), and sufentanilonly group(150 ugsufentanil+4 mg tropisetron,C). The VAS score and RAMSAY score at moments of T₁(0.5 h), T₂(2 h), T₃(6 h), T₄(12 h) and T₅(24 h) after surgery were observed. The level of CRP, TNF-a and IL-10 in patients' blood samples and adverse reactions during the 48 hours after surgery were detected. Results: Compared with C group(sufentanil group), the VAS score in group H(high dose group) at T_2-5, in group M(moderate dose group) at T_3-5, in group L(low dose group) at T_3-4 were significantly decreased, and the Ramsay score in L group at T_3-4, in M group at T_3-5, in H group at T_2-5were significantly increased; But, compared to group C, in the three groups, the level of CRP, TNF-a at T_2-5 were significantly decreased, and the level of IL-10 was significantly increased, The differences were both statistically significant. And the adverse reaction rate in group H was 52.5%, in group C was 47.5%, which was significantly higher than that in group M(12.5%) and group L(10%), and the difference was statistically significant.Conclusion: Using dexmedetomidine in patients undergoing thoracotomy significantly improves the effect of sufentanil mediated PCIA, and the higher dose of dexmedetomidine, the quicker analgesic effect. But the appropriate dose reduction can ensure reduced adverse reactions while ensuring the the analgesic effect, dexmedetomidine 1 g/kg being the ideal dose.

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