右美托咪定在腔镜甲状腺手术患者术后镇痛中的临床观察

目的:观察右美托咪定对腔镜甲状腺手术患者术后静脉镇痛(PCIA)的镇痛效果及其对术后不良反应的影响。方法:选择腔镜甲状腺切除手术患者40例,随机均分为两组。A组手术结束前15 min静脉缓慢推注生理盐水作为负荷量,手术结束即刻行PCIA(枸橼酸舒芬太尼100μg+格拉斯琼6 mg);B组手术结束前15 min静脉缓慢推注右美托咪定0.8μg/kg作为负荷量,手术结束即刻行PCIA(右美托咪定200μg+格拉斯琼6 mg)。记录术后2 h、4 h、8 h、24 h、48 h的VAS镇痛、Ramsay镇静评分,观察患者术后恶心呕吐、心动过缓、低血压或高血压、呼吸抑制及低氧血症等不良反应发生的例数和比率。结果:B组患者VAS镇痛评分、Ramsay镇静评分优于A组,其差异有统计学意义(P<0.05);且B组术后恶心呕吐等不良反应的发生率明显低于A组(P<0.05)。结论:右美托咪定可为腔镜甲状腺切除手术患者提供良好的镇静、镇痛作用,且不良反应少,可以安全有效地用于腔镜甲状腺切除手术患者的术后镇痛。

Analgesic efficacy of dexmedetomidine in patients after endoscopic thyroidectomy

Objective：To observe the efficacy and adverse effects of dexmedetomidine for patients-controlled intravenous analgesia（PCIA） in patients after endoscopic thyroidectomy.Methods：Forty patients undergoing elective endoscopic thyroidectomy were equally randomized into 2 groups.The patients in group A received normal saline as load capacity 15 min before the procedure completion via intravenous bolus,followed by PCIA（100 μg sufentanil citrate＋6 mg granisetron） right at the end of the surgery,and those in group B were managed with dexmedetomidine in dose of 0.8 μg/kg 15 min before surgery completion.PCIA（200 μg dexmedetomidine＋6 mg granisetron）was performed immediately after the procedure.The Visual Analog Scale（VAS） and Ram-say Sedation Score（ RSS） were maintained at postoperative 2 h,4 h,8 h,24 h and 48 h,respectively,and the two groups were also observed regarding the postoperative adverse events,including the case incidence and ratio of nausea and vomiting,bradycardia,hypotension,hypertension,respiratory depression and hyoxemia.Results：Group B had significantly improved scores of VAS and RSS and lower incidences of postoperative adverse events than group A （ P〈0.05）.Conclusion：Dexmedetomidine can be safe and effective PCIA for patients undergoing endoscopic thyroidectomy,for it may achieve better seda-tion and analgesic effects,yet reduce the side effects.