摘要
目的评价右美托咪定滴鼻对胸腔镜下肺癌根治术患者苏醒期镇静镇痛的影响。方法择期全麻下行胸腔镜下肺癌根治术患者120例,男67例,女53例,年龄38~65岁,BMI 18.9~24.6 kg/m^2,ASAⅠ或Ⅱ级,TNM分期Ⅱ或Ⅲ期,采用随机数字表法将患者分为三组(n=40):右美托咪定静脉组(DV组)、右美托咪定滴鼻组(DN组)和对照组(C组)。DV组于关胸前静脉泵注右美托咪定1μg/kg(生理盐水稀释为10 ml,10 min注完);DN组于关胸前双侧鼻孔等量滴入右美托咪定1μg/kg(生理盐水稀释为1 ml),滴速为20滴/分;C组给予等量生理盐水滴鼻。术后患者均采用舒芬太尼PCIA。于拔管后5 min、用药后1、2 h记录Ricker镇静躁动评分(SAS评分)和VAS疼痛评分,记录术后首次追加舒芬太尼时间,术后24 h舒芬太尼总用量和不良反应发生情况。结果与C组比较,DN组和DV组SAS评分在拔管后5 min和用药后1 h明显降低,拔管后5 min VAS评分明显降低,术后首次追加舒芬太尼时间明显延长,术后24 h内舒芬太尼总用量明显减少,出现呛咳反应、高血压和心动过速情况明显减少(P<0.05);与DV组比较,DN组心动过缓发生率明显降低(P<0.05)。结论右美托咪定静注和滴鼻可改善胸腔镜下肺癌根治术患者苏醒期镇静水平,减少术后阿片类药物使用,同时,滴鼻方式简便易行,临床安全性较高。
Objective To evaluate the effects of intranasal dexmedetomidine on sedation and analgesia of emergence undergoing thoracoscopic resection of lung cancer.Methods A total of 120 patients,67 males and 53 females,aged 38-65 yeras,with a BMI 18.9-24.6 kg/m^2,falling into ASA physical statusⅠorⅡcategory,scheduled for thoracoscopic resection of lung cancer under general anesthesia,were equally and randomly assigned into 3 groups,groups DN,DV and C.Dexmedetomidine 1μg/kg diluted into 10 ml was infused in 10 min in group DV.Dexmedetomidine 1μg/kg was instilled into the bilateral nostrils before suture in group DN(20 drips/min),and normal saline were instilled in group C.Sufentanil was used in PCIA.Ricker sedation agitation scale(SAS)and visual analogue scale(VAS)were recorded at 5 min after extubation,1 h and 2 h after administration.The first time of additional sufentanil,total amount of sufentanil in 24h after surgery,and adverse effects were recorded.Results Compared with group C,SAS was decreased at 5 min after extubation and 1 h after administration,the first time of additional sufentanil was prolonged,total sulfentanil were reduced,and the rate of bucking,hypertension,tachycardia was decreased in group DN(P<0.05).Compared with group DV,the rate of bradycardia was lower in group DN(P<0.05).Conclusion Dexmedetomidine administered intransally can improve the effect of sedation during emergence,reduce the total dose of opioid and is safer than iv administration.
作者
王寅雪
赵洪伟
WANG Yinxue;ZHAO Hongwei(Department of Anesthesiology,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2020年第1期35-38,共4页
Journal of Clinical Anesthesiology
关键词
右美托咪定
滴鼻
镇静
镇痛
Dexmedetomidine
Intranasal
Sedation
Analgesia
