盐酸右美托咪定复合舒芬太尼用于宫颈癌根治术后镇痛的疗效观察

目的 观察盐酸右美托咪定复合舒芬太尼用于全麻下宫颈癌根治术术后镇痛的临床效果,为指导临床合理用药提供依据.方法 选择择期行宫颈癌根治手术患者72例,ASA分级I-II级,随机分为三组：I组：舒芬太尼1.0μg/kg＋格拉司琼6mg;II组：舒芬太尼1.5μg/kg＋格拉司琼6mg;III组：舒芬太尼1.0μg/kg＋右美托咪定1.0μg/kg＋格拉司琼6mg.记录拔管后1、6、12、24 h患者疼痛VAS评分,拔管后即刻和拔管后l h的Ramsay镇静评分以及术后不良反应.结果 三组患者在术后1h的VAS评分没有统计学差异,术后6~12h,Ⅱ组和Ⅲ组患者的VAS评分均明显低于I组（P〈0.05或P〈0.01）.Ⅲ组的患者拔管后1h Ramsay镇静评分明显低于Ⅰ和Ⅱ组,差异有统计学意义（P〈0.05）.与另外两组相比,Ⅱ组恶心呕吐的发生率较高（P〈0.05）.而III组心动过缓的发生率较Ⅰ组和Ⅱ组明显增加（P〈0.05）.结论 联合使用右美托咪定和舒芬太尼用于术后镇痛可以减少舒芬太尼的用量,在起到良好镇痛镇静效果的同时,减少了大剂量舒芬太尼导致的恶心呕吐的发生率,但是增加了心动过缓的发生率,加强监测可以避免.

Effect of dexmedetomidine combined with sufentanil on postoperative analgesia in patients undergoing redical operation for cervical cancer

Objective To observe the clinical effect of dexmedetomidine combined with sufentanil on postoperative anal- gesia in patients who underwent redical operation for cervical cancer with general anesthesia and provide the evidence for rational drug use. Method 72 patients with ASA status I-II undergoing redical operation for cervical cancer were randomly divided to three groups： group I received sufentanil 1.01xg/kg ＋ granisetron 6 mg; group II： sufentanil 1.5 ~g/kg and granisetron 6mg; group III： 1.01xg/kg, dexmedetomidine 1.01xg/kg and granisetron 6mg. Visual analog scale （VAS） was recorded for evaluating the pain af- ter extubation for 1, 6, 12 and 24 hours. Ramsay scores were used to evaluated sedation immediate and after extubation for 1 h. Adverse reactions after operation were also investigated. Results There was no significant difference about VAS after operation 1 h among three groups. However, VAS in group I1 and III were lower than that in group I after operation 6,12h （P 〈0. 05 or P 〈0.O1 ）. Ramsay scores in group llI was lower than that in group I and ]]I after extubation lh （P 〈0. 05）. The incidence of nausea and omitting in group II and bradycardia in group 11I was higher （ P 〈 O. 05 ）. Conclusion Dexmedetomidine combined with sufentanil on postoperative analgesia reduced the doze of sufentanil and incidence of nausea and omitting, however, increased the in- cidence of bradycardia. It needed enhancement of monitoring.