[1]王 丽,郭帅锋,李书平,等.右美托咪定不同方案对胸外科术后患者镇痛效果临床观察[J].陕西医学杂志,2023,52(9):1228-1232.[doi:DOI:10.3969/j.issn.1000-7377.2023.09.027]
　WANG Li,GUO Shuaifeng,LI Shuping,et al.Ananlgesic effects of different regimens of dexmedetomidine on patients after thoracic surgery[J].,2023,52(9):1228-1232.[doi:DOI:10.3969/j.issn.1000-7377.2023.09.027]
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右美托咪定不同方案对胸外科术后患者镇痛效果临床观察
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
52
期数:
2023年9期
页码:
1228-1232
栏目:
药物与临床
出版日期:
2023-09-05

文章信息/Info

Title:
Ananlgesic effects of different regimens of dexmedetomidine on patients after thoracic surgery
作者:
王 丽1; 郭帅锋1; 李书平2; 董蜀华1
(1.成都医学院第一附属医院麻醉科,四川 成都 610500; 2.成都医学院第一附属医院急诊科,四川 成都 610500)
Author(s):
WANG Li; GUO Shuaifeng; LI Shuping; DONG Shuhua
(Department of Anesthesiology,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)
关键词:
右美托咪定;  分时段镇痛;  镇静;  咳嗽、咳痰能力;  生活质量;  术后并发症
Keywords:
Dexmedetomidine;  Time-phased analgesia;  Sedation;  Ability to cough and expectorate;  Quality of life;  Postoperative complications
分类号:
R 614.3
DOI:
DOI:10.3969/j.issn.1000-7377.2023.09.027
文献标志码:
A
摘要:
目的:探讨右美托咪定不同方案对胸外科术后患者的效果。方法:选取胸外科手术治疗且需要术后镇痛患者60例,采用随机数字表法分为D0组、D全组和D时组,每组20例。D0组给予全程传统静脉自控镇痛(PCIA)方案。D全组在D0组基础上加用200 μg右美托咪定。D时组给予分时段术后镇痛方案。比较三组患者术后不同时间点疼痛视觉模拟量表(VAS)评分、美国国立卫生研究院卒中量表-1a意识(NIHSS-1a)评分、改良Barthel指数量表(MBI)评分、半定量咳嗽强度(SCSS)评分、生理指标[平均动脉压(MAP)、心率(HR)、呼吸频率(RR)和血氧饱和度(SpO2)]以及术后7 d内并发症发生情况。结果:术后第6小时,D0组VAS评分高于D全组和D时组(均P<0.05)。术后第12、24、36、48、72小时,以及第4、7天,D时组和D全组VAS评分低于D0组,且D全组低于D时组(均P<0.05)。术后第3、4、7天,D时组MBI评分高于D0组和D全组,且D0组高于D全组(均P<0.05)。术后第24小时,D0组、D时组NIHSS-1a评分低于D全组(均P<0.05)。术后第36、48、72小时,D时组NIHSS-1a评分低于D0组和D全组,且D0组低于D全组(均P<0.05)。术后第3、4、7天,D时组MBI评分高于D0组和D全组,且D0组高于D全组(均P<0.05)。术后第48小时,D0组、D时组SCSS评分高于D全组(均P<0.05); 三组患者MAP、HR、RR和SpO2水平比较差异无统计学意义(均P>0.05)。术后7 d内,三组患者并发症发生率比较差异无统计学意义(均P>0.05)。 结论:右美托咪定术后分时段镇痛方案可有效降低胸外科患者术后疼痛程度,不易出现麻醉药物镇静过度现象,且对患者术后咳嗽及日常生活能力有积极影响,对患者术后生理指标及并发症影响较小,具有较好的安全性。
Abstract:
Objective:To investigate the effects of different regimens of dexmedetomidine on patients after thoracic surgery.Methods:Sixty patients undergoing thoracic surgery and requiring postoperative analgesia were randomly divided into D0 group,Dwhole group and Dtime group,with 20 cases in each group.Patients in D0 group were given whole course of traditional PCIA.Dwhole Group was treated with 200 μg dexmedetomidine in addition to D0 group.Patients in Dtime group were given postoperative time-phased analgesia.The VAS score,NIHSS-1a score,MBI score,SCSS score,physiological indexes(MAP,HR,RR and SpO2)at different time points after operation,and complications within 7 days after operation were compared among the three groups.Results:At 6 hours after operation,VAS score in D0 group was higher than that in Dwhole group and Dtime group(both P<0.05).At 12,24,36,48,72 hours,and 4,7 days after operation,the VAS scores of Dwhole group and Dtime group were lower than those of D0 group,and the VAS scores of Dwhole group were lower than those of Dtime group(all P<0.05).On the 3rd,4th and 7th day after operation,the MBI scores of Dtime group was higher than that of D0 group and Dwhole group,and that of D0 group was higher than Dwhole group(all P<0.05).At 24 hours after surgery,NIHSS-1a scores in D0 group and Dtime group were lower than that in Dwhole group(all P<0.05).At 36,48 and 72 hours after operation,the NIHSS-1a score in Dtime group was lower than that in D0 group and Dwhole group,and that in D0 group was lower than that in Dwhole group(all P<0.05).On the 3rd,4th and 7th day after operation,the MBI score of Dtime group was higher than that of D0 group and Dwhole group,and that of D0 group was higher than Dwhole group(all P<0.05).At 48 hours after operation,the SCSS scores of D0 group and Dtime group were higher than that of the whole Dwhole group(all P<0.05).There were no significant differences in MAP,HR,RR and SpO2 levels among the three groups(all P>0.05).There was no significant difference in the incidence of complications among the three groups within 7 days after operation(all P>0.05).Conclusion:Time-phased analgesia with dexmedetomidine can effectively reduce the degree of postoperative pain in patients undergoing thoracic surgery,and will not easily show excessive sedation.It has a positive effect on postoperative cough and daily living ability of patients,and has little effect on postoperative physiological indexes and complications,with good safety.

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备注/Memo

备注/Memo:
基金项目:四川省科技厅科研项目(2023NSFSC1571); 成都医学院校基金资助项目(CYCG18-02); 成都医学院第一附属医院专项科学研究基金资助项目(CYFY2018YB10)
更新日期/Last Update: 2023-09-04