右美托咪定复合地佐辛用于老年高血压患者胸腔镜手术的预防性镇痛效果

Prophylactic analgesic effects of dexmedetomidine in combination with dezocine in the hypertensive elderly patients undergoing thoracoscopic surgery

摘要:

目的 评价右美托咪定复合地佐辛用于老年高血压患者胸腔镜手术的预防性镇痛效果。方法 选择河北省人民医院行胸腔镜下肺叶切除术的老年高血压患者80例,性别不限,年龄65～80岁,采用随机数字表法分为4组(n=20):右美托咪定组(DEX组)、地佐辛组(DEZ组)、右美托咪定+地佐辛组(DD组)、对照组(C组)。DEX组:从手术开始至缝皮时静脉输注右美托咪定0.4 μg/(kg·h)；DEZ组:麻醉诱导前15 min及缝皮时静脉注射地佐辛0.1 mg/kg；DD组:麻醉诱导前15 min静脉注射地佐辛0.1 mg/kg,继从手术开始至缝皮时静脉输注右美托咪定0.4 μg/(kg·h),同时缝皮时静脉注射地佐辛0.1 mg/kg；C组:给予等容量的生理盐水。4组患者均于入麻醉恢复室(PACU)时开启经静脉患者自控镇痛(PCIA)泵。于麻醉诱导前20 min(T₁),缝皮时(T₂),拔除气管导管后即刻(T₃)、5 min(T₄)、30 min(T₅)时抽取肘静脉血测定患者血浆中去甲肾上腺素(NE)浓度。记录患者T₄、T₅、拔除气管导管后60 min(T₆)各时点的Ramsay镇静评分及苏醒期躁动程度。记录患者术后1 h(T₇)、4 h(T₈)、12 h(T₉)、24 h(T₁₀)视觉模拟评分(VAS)及术后24 h PCIA泵按压次数和背景输注总量。观察4组患者术后不良反应发生情况。应用SPSS 21.0统计软件对数据进行分析。结果 与DEX组和DEZ组比较,DD组患者在T₂～T₅时血浆中NE浓度明显降低(P<0.05)。与DEX组和DEZ组比较,DD组患者在T₄～T₆时Ramsay镇静评分明显升高,苏醒期躁动程度降低(P<0.05)。与DEX组和DEZ组比较,DD组患者在T₇～T₁₀时VAS明显降低,术后24 h PCIA泵按压次数和背景输注总量明显减少(P<0.05)。与DEX组和DEZ组比较,DD组患者高血压和恶心呕吐发生率降低(P<0.05)。结论 右美托咪定复合地佐辛用于老年高血压患者胸腔镜手术可产生良好的预防性镇痛效果,有助于减轻应激反应,减少苏醒期躁动,降低术后疼痛程度。

Abstract:

Objective To assess the prophylactic analgesic effects of dexmedetomidine in combination with dezocine in the hypertensive elderly patients undergoing thoracoscopic surgery. Methods Eighty patients of both genders (age, 65-80 years) scheduled for elective thoracoscopic lobectomy under general anesthesia were randomly divided into 4 groups:dexmedetomidine group (DEX group), dezocine group (DEZ group), dexmedetomidine+dezocine group (DD group), and control group (C group). Patients in DEX group received intraoperative intravenous infusion of dexmedetomidine at 0.4 μg/(kg·h). In DEZ group, dezocine 0.1 mg/kg was injected intravenously 15 min prior to the induction of anesthesia and at the time of suturing. In DD group, dezocine 0.1 mg/kg was injected intravenously 15 min prior to the induction of anesthesia, followed by intraoperative intravenous infusion of dexmedetomidine 0.4 μg/(kg·h) and subsequent intravenous injection of dezocine at the time of suturing. Normal saline of equal volume was administered in C group. Patient-controlled intravenous analgesia (PCIA) was started for all patients when they were transferred to the Post-anesthesia Care Unit (PACU). Venous blood samples were collected for measuring the plasma norepinephrine (NE) 20 min prior to the induction of anesthesia (T₁), at the time of suturing (T₂), immediately post-extubation (T₃), 5 min post-extubation(T₄) and 30 min post-extubation (T₅). The Ramsay scores at T₄, T₅ and 60 min post-extubation and degree of emergence agitation were recorded.Resting visual analogue score (VAS) at postoperative 1 h (T₇), 4 h (T₈), 12 h (T₉), and 24 h (T₁₀), and frequency of PCIA button pressing and consumption of analgesics during postoperative 24 hours were also recorded. The postoperative adverse reactions were observed for all the patients. SPSS statistics 21.0 was used for data analysis. Results The plasma NE was significantly decreased in DD group than DEX group and DEZ group from T₂ to T₅ (P<0.05). Ramsay scores at T₄-T₆ were significantly higher and the emergence agitation during recovery period significantly lower in DD group than DEX group and DEZ group (P<0.05). VAS at T₇-T₁₀, frequency of PCIA button pressing and consumption of analgesics during postoperative 24 hours were significantly lower in DD group than DEX group and DEZ group (P<0.05). The incidences of hypertension, nausea and vomiting were significantly lower in DD group than DEX group and DEZ group (P<0.05). Conclusion Dexmedetomidine in combination with dezocine exerts satisfactory prophylactic analgesic effects in the hypertensive elderly patients undergoing thoracoscopic surgery, relieving the stress reaction, decreasing the emergence agitation and reducing the postoperative pain.