[1]卢志方,郭 斌,董补怀,等.单纯全身麻醉与复合硬膜外应用右美托咪定和吗啡麻醉203例对比研究[J].陕西医学杂志,2020,49(7):858-861.[doi:DOI:10.3969/j.issn.10007377.2020.07.025]
点击复制

单纯全身麻醉与复合硬膜外应用右美托咪定和吗啡麻醉203例对比研究
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
49
期数:
2020年7期
页码:
858-861
栏目:
临床研究
出版日期:
2020-07-05

文章信息/Info

作者:
卢志方; 郭 斌; 董补怀; 高子军△
西安交通大学附属红会医院(西安 710054)
关键词:
右美托咪定;  腹部术后;  肠道蠕动功能;  全身麻醉;  硬膜外麻醉术
分类号:
R614.2
DOI:
DOI:10.3969/j.issn.10007377.2020.07.025
文献标志码:
A
摘要:
目的:比较硬膜外使用右美托咪定(Dex)或吗啡加0.125%左旋布比卡因复合全麻及全身麻醉对结直肠癌手术患者术后镇痛及肠蠕动功能恢复的影响。方法:收集结直肠癌手术203例,根据不同麻醉方法分为三组:右美托咪定组(D组)采用全身麻醉复合硬膜外应用右美托咪定的麻醉方式,吗啡组(M组)采用全身麻醉复合硬膜外应用吗啡的麻醉方式,全麻组(G组)采用单纯全身麻醉的方法。分析术后2、4、6、8、12、16、24、48 h的安静状态下和活动状态下的镇痛以及镇静评分。比较三组术后恶心、呕吐、皮肤瘙痒、低血压等一些并发症的发生率,以及术后首次出现排气、排便的时间。结果:术后初次排气时间和初次排便时间,D组与M组和G组之间比较有统计学意义(P<0.05)。D组术后并发症有更低的恶心、呕吐发生率(P<0.05),并且没有一例患者出现皮肤瘙痒症状; M组皮肤瘙痒症状明显; G组恶心、呕吐发生率高,无皮肤瘙痒,但心动过缓和低血压的发生率比较无统计学差异。术后48 h安静疼痛评分:三组患者镇痛评分在不同时间点上比较有统计学差异(P<0.05), 三组患者镇痛评分在同一时间点上比较有统计学差异(P<0.05),D组和M组间同一时间点的镇痛评分比较无统计学差异(P>0.05),G组和D组、M组间镇痛评分比较均有统计学差异(P<0.05)。术后48 h运动疼痛评分:三组患者镇痛评分在不同时间点上比较有统计学差异(P<0.05),三组患者镇痛评分在同一时间点上比较有统计学差异(P<0.05),D组和M组、G组间镇痛评分比较均有统计学差异(P<0.05),M组和G组间镇痛评分比较也有统计学差异(P<0.05)。D组与M组之间第一次给予镇痛药的时间和给予总镇痛药剂量比较无统计学差异,G组在第一次给予镇痛药的时间明显早于前两组,给予总镇痛药剂量也多于D组与M组。结论:硬膜外右美托咪定和左旋布比卡因复合应用与吗啡和左旋布比卡因复合应用,镇痛效果满意的同时对肠道蠕动功能的恢复影响较小; 与吗啡组和全麻组相比,右美托咪定组术后并发症少。

参考文献/References:

[1] Holte K,Kehlet H.Postoperative ileus:a preventable event[J].Br J Surg,2000(87):1480-1493.
[2] Thorn SE,Wattwil M,Naslund I.Postoperative epidural morphine,but not epidural bupivacaine,delays gastric emptying on the first day after cholecystectomy[J].Reg Anesth,1992(17):91-94.
[3] Ebert TJ,Hall JE,Barney JA,et al.The effects of increasing plasma concentrations of dexmedetomidine in humans[J].Anesthesiology,2000(93):382-394.
[4] 张阿曼,裴晓娟,张 鸿.右美托咪定对行腹腔镜术妇科疾病患者术后疼痛及安全性影响[J].陕西医学杂志,2018,47(1):87-89.
[5] Esmaoglu A,Yegenoglu F,Akin A,et al.Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block[J].Anesth Analg,2010(111):1548-1551.
[6] El-Hennawy AM,Abd-Elwahab AM,Abd-Elmaksoud AM,et al.Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children[J].Br J Anaesth,2009,103(2):268-274.
[7] Zeng XZ,Xu YM,Cui XG,et al.Low-dose epidural dexme-detomidine improves thoracic epidural anaesthesia for nephrectomy[J].Anaesth Intensive Care,2014(42):185-190.
[8] Ruffolo RR,Jr Nichols AJ,Stadel JM,et al.Pharmacologic and therapeutic applications of alpha 2-adrenoceptor subtypes[J].Annu Rev Pharmacol Toxicol,1993(33):243-279.
[9] Yoshitomi T,Kohjitani A,Maeda S,et al.Miyawaki T.Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor[J].Anesth Analg,2008(107):96-101.
[10] Fairbanks CA,Stone LS,Kitto KF,et al.Alpha(2C)-adrenergic receptors mediate spinal analgesia and adrenergic-opioid synergy[J].J Pharmacol Exp Ther,2002(300):282-290.
[11] Memis D,Dokmeci D,Karamanlioglu B,et al.A comparison of the effect on gastric emptying of propofol or dexmedetomidine in critically ill patients:preli minary study[J].Eur J Anaesthesiol,2006(23):700-741.
[12] Ravindran RS,Turner MS,Muller J.Neurologic effects of subarachnoid ad ministration of 2-chloroprocaine-CE,bupivacaine,and low pH normal saline in dogs[J].Anesth Analg,1982(61):279-283.
[13] Vieira AM,Schnaider TB,Brandao AC,et al.Epidural clo-nidine or dexmedetomidine for post-cholecystectomy analgesia and sedation[J].Rev Bras Anestesiol,2004(54):473-478.
[14] Solanki SL,Bharti N,Batra YK,et al.The analgesic eff-ect of intrathecal dexmedetomidine or clonidine,with bupivacaine,in trauma patients undergoing lower limb surgery:a randomised,double-blind study[J].Anaesth Intensive Care,2013(41):51-56.
[15] Gupta R,Bogra J,Verma R,et al.Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia[J].Indian J Anaesth,2011(55):347-351.
[16] Zhang H,Zhou F,Li C,et al.Molecular mechanisms underlying the analgesic property of intrathecal dexmedetomidine and its neurotoxicity evaluation:an in vivo and in vitro experimental study[J].PLoS One,2013(8):e55556.

相似文献/References:

[1]区浩林.右美托咪定联合瑞芬太尼TCI清醒镇静镇痛在输尿管镜钬激光碎石术中临床研究*[J].陕西医学杂志,2019,(1):32.
[2]顾国清,张海东,唐 鸣.髋关节置换患者术后镇痛中右美托咪定应用浓度研究[J].陕西医学杂志,2019,(3):370.
　GU Guoqing,ZHANG Haidong,TANG Ming.Study on the application concentration of dexmedetomidine in postoperative analgesia for patients with hip replacement[J].,2019,(7):370.
[3]谢 力,贺宏智△,何 恒.右美托咪定对79例椎管内麻醉手术患者应激反应的影响研究[J].陕西医学杂志,2019,(3):373.
　XIE Li,HE Hongzhi,HE Heng.Clinical effect of dexmedetomidine on stress response in 79patients undergoing intraspinal anesthesia[J].,2019,(7):373.
[4]周维纲,王宇波△,杨建治,等.右美托咪定对分娩镇痛产妇产程和脐动脉血气的影响*[J].陕西医学杂志,2019,(8):1074.
　ZHOU Weigang,WANG Yubo,YANG Jianzhi,et al.Effect of dexmedetomidine on the duration of labor and umbilical artery blood gas in painless parturient[J].,2019,(7):1074.
[5]刘 明,常红侠△.右美托咪定复合罗哌卡因腹横肌平面阻滞对腹腔镜下腹股沟〖JZ〗斜疝高位结扎术患儿血流动力学及麻醉质量的影响研究*[J].陕西医学杂志,2019,(10):1268.
　LIU Ming,CHANG Hongxia..Effects of dexmedetomidine combined with ropivacaine on the transverse hemifacial plane block on〖JZ〗hemodynamics and anesthesia quality in children undergoing high ligation of inguinal hernia[J].,2019,(7):1268.
[6]冯 健,邓挚玺△.右美托咪定联合舒芬太尼与右美托咪定联合地佐辛〖JZ〗用于胶质瘤患者术后镇痛临床研究*[J].陕西医学杂志,2019,(10):1289.
[7]秦 悦,董补怀,赵元廷,等.多模式镇痛对老年颈后路手术患者血流动力学及术后早期疼痛效果研究[J].陕西医学杂志,2019,(10):1355.
　QIN Yue,DONG Buhuai,Zhao Yuanting,et al.Effect of multimodal analgesia on hemodynamics and early postoperative 〖JZ〗pain in elderly patients with posterior cervical surgery[J].,2019,(7):1355.
[8]和优娟,喻 倩,庄莹莹△.右美托咪定复合全麻对急性脑出血患者脑保护作用研究*[J].陕西医学杂志,2019,(12):1702.
　HE Youjuan,YU Qian,ZHUANG Yingying.Cerebral protection effect of dexmedetomidine combined with general anesthesia on patients with acute cerebral hemorrhage[J].,2019,(7):1702.
[9]张力召,魏光辉.右美托咪定滴鼻联合七氟醚吸入对磁共振成像检查婴幼儿镇静作用的研究*[J].陕西医学杂志,2020,49(1):93.
[10]霍建臻,刘 江△.右美托咪定在喉镜下声带手术麻醉中的应用效果分析[J].陕西医学杂志,2020,49(6):745.[doi:DOI:10.3969/j.issn.10007377.2020.06.026]

更新日期/Last Update: 2020-07-28