右美托咪定对直肠癌根治术患者氟比洛芬酯多模式镇痛效果的影响

发布时间：2019-06-18 12:54

【摘要】：目的:1.研究右美托咪定对直肠癌根治术患者氟比洛芬酯多模式镇痛效果的影响。2.评价右美托咪定对直肠癌根治术患者氟比洛芬酯多模式镇静效果的影响。3.探讨右美托咪定对氟比洛芬酯多模式镇痛患者应激反应和炎症反应的影响。4.讨论右美托咪定对氟比洛芬酯多模式镇痛患者不良反应的影响。方法:选取2016年1月至2016年5月于天津医科大学肿瘤医院择期行直肠癌切除术的肿瘤患者共90例,随机分为3组,每组30例。A、B两组手术开始前30min缓慢静脉滴注氟比洛芬酯1mg/kg行超前镇痛,C组为对照组,手术开始前30min缓慢静脉滴注5ml脂肪乳。麻醉诱导:依次静注咪达唑仑0.03mg/kg、舒芬太尼0.3μg/kg、丙泊酚2mg/kg、罗库溴铵0.6mg/kg,充分去氮给氧后行气管插管操作,连接麻醉机控制呼吸,调整呼吸参数并维持气道压≤20cm H2O、PETCO2 35~45 mm Hg。麻醉维持:术中恒速输注丙泊酚、瑞芬太尼维持麻醉深度,保持BIS值40~60。术毕送往麻醉苏醒室观察,留观30min时监测患者术后血糖,待患者各项指标符合相应标准后送返病房。术后患者静脉自控镇痛泵配制方法:A组(右美托咪定联合氟比洛芬酯多模式镇痛组)右美托咪定2μg/kg+氟比洛芬酯2mg/kg+舒芬太尼2μg/kg;B组(氟比洛芬酯多模式镇痛组)氟比洛芬酯2mg/kg+舒芬太尼2μg/kg;C组(对照组)舒芬太尼2μg/kg+脂肪乳10ml;三组均加生理盐水至100ml。镇痛泵流速1ml/h,单次按压量1ml,锁定时间15min。分别记录术后4h(T1)、8h(T2)、12h(T3)、24h(T4)、48h(T5)各时间点咳嗽时疼痛视觉模拟评分(VAS)以及Ramsay镇静评分;记录术后24h内患者自控静脉镇痛泵有效按压次数及舒芬太尼用药量;记录术前及术后30min血糖、术前及术后48h内C反应蛋白(C-reactive protein,CRP);观察术后48h内加强镇痛例数及不良反应(恶心呕吐、头晕头痛、皮肤瘙痒、尿潴留、呼吸抑制、心动过缓等)例数。结果:1.A组T1、T2、T3咳嗽时VAS评分明显小于B、C两组(P0.05)。A组24h内止疼泵有效按压次数、舒芬太尼用药量明显小于B、C两组(P0.05)。三组加强镇痛例数差异无统计学意义。2.A组T1、T2时Ramsay镇静评分高于B、C组(P0.05)。3.A组术后30min血糖和术后48h CRP明显小于B、C两组(P0.05)。4.A、B两组间不良反应例数无统计学意义且均低于C两组(P0.05)。结论:右美托咪定联合氟比洛芬酯多模式镇痛用于直肠癌根治术患者,可增强其镇痛、镇静效果,减少应激和炎症反应,降低不良反应的发生风险。
[Abstract]:Objective: 1. To study the effect of dexmetiomide on multimode analgesia of flavibiprofen ester in patients undergoing radical resection of rectal cancer. 2. To evaluate the effect of dexmetiomide on multimode sedation of fluorobiprofen ester in patients undergoing radical resection of rectal cancer. 3. To investigate the effect of dexmetiomide on stress response and inflammatory response in patients with flavibiprofen multimode analgesia. 4. To discuss the effect of dexmetiomide on adverse reactions in patients with flavibiprofen multimode analgesia. Methods: from January 2016 to May 2016, 90 patients with rectal cancer were randomly divided into 3 groups with 30 patients in each group. Group A and group B underwent preemptive analgesia with slow intravenous drip of flubiprofen ester 1mg/kg before the beginning of the operation, while group C was the control group. 30min was slowly infused with 5ml fat emulsion before the beginning of the operation. Anesthesia induction: intravenous injection of midazolam 0.03 mg 路kg ~ (- 1), sufentanil 0.3 渭 g / kg, propofol 2 mg 路kg ~ (- 1), rocuronium 0.6 mg 路kg ~ (- 1), trachea intubation after full denitrification and oxygen supply, connecting anesthetic machine to control respiration, adjusting respiratory parameters and maintaining airway pressure 鈮，

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