右美托咪定应用于喉癌患者术后置入气切套管中的镇痛镇静效果

发布时间：2018-08-24 18:59

【摘要】：目的探讨右美托咪定对喉癌患者术后气管切开后置入气切套管的镇静和镇痛效果。方法选择2013—2015年于厦门大学附属第一医院择期行全麻下喉癌根治术的患者60例,随机分成右美托咪定组(D组)和对照组(C组),每组30例。D组患者静脉泵注盐酸右美托咪定0.5μg/kg,15min后改为0.3μg·kg-1·min-1持续泵注;C组患者静脉泵注等量的0.9%氯化钠溶液,两组患者均于手术结束前30min停止泵注。比较两组患者的手术时间、苏醒时间、苏醒期间咳嗽、镇静评分、追加芬太尼次数及气管切开前(T0),苏醒时(T1)、苏醒后5min(T2)、苏醒后10min(T3)、苏醒后30min(T4)患者心率(HR)、平均动脉压(MAP)和呼吸(RR)的变化情况。结果两组患者手术时间和苏醒时间比较,差异无统计学意义(P0.05)。HR、RR、MAP时间和方法有交互作用(P0.05);时间间比较,差异有统计学意义(P0.05);组间比较,差异有统计学意义(P0.05)。T1时间点两组患者HR、RR、MAP均高于T0时间点,差异有统计学意义(P0.05);T1时间点C组HR、RR、MAP均高于D组,差异有统计学意义(P0.05);T3时间点两组患者HR、MAP下降到T0水平,C组RR低于T0点,差异有统计学意义(P0.05)。镇静与咳嗽评分时间和方法有交互作用(P0.05);时间间比较,差异有统计学意义(P0.05);组间比较,差异有统计学意义(P0.05)。T1、T2、T3、T4时间点C组患者镇静评分低于D组,差异有统计学意义(P0.05);T3时间点两组患者镇静评分高于T0点,差异有统计学意义(P0.05);T1、T2、T3、T4时间点C组患者咳嗽评分高于D组,差异有统计学意义(P0.05);T3时间点两组患者咳嗽评分低于T0点,差异有统计学意义(P0.05)。D组患者追加芬太尼次数(8次)少于C组(26次),差异有统计学意义(P0.05)。结论持续泵注右美托咪定能够有效抑制喉癌患者术后置入气管套管苏醒期的呛咳反应,维持患者血流动力学稳定,镇痛、镇静作用明显,且不影响苏醒。
[Abstract]:Objective to investigate the sedative and analgesic effects of dexmetomidine on tracheotomy after tracheotomy in patients with laryngeal cancer. Methods 60 patients with laryngeal cancer undergoing radical laryngectomy under general anesthesia were selected from the first affiliated Hospital of Xiamen University from 2013 to 2015. They were randomly divided into two groups: group D (group D) and group C (group C). 30 patients in group D received intravenous injection of dexmetidine hydrochloride at a dose of 0.5 渭 g / kg / kg for 15 minutes. The intravenous infusion of 0.9% sodium chloride solution in group C was changed to 0.3 渭 g kg-1 min-1 continuous pump. All patients in both groups were treated with 30min before the end of operation. The operative time, cough and sedation score during recovery were compared between the two groups. Before tracheotomy (T0), during recovery (T1), 5min (T2) after awakening, 10min (T3) after awakening, (MAP) and respiratory (RR) in patients with 30min (T4) after awakening. Results there was no significant difference in operation time and recovery time between the two groups (P0.05). The time and method of RRN map had interaction (P0.05), the difference between the two groups was statistically significant (P0.05), the difference between the two groups was statistically significant (P0.05), the difference between the two groups was significant (P0.05), the difference between the two groups was significant (P0.05). The difference was statistically significant (P0.05). The HR,RR,MAP of the two groups was significantly higher than that of the T0 time point (P0.05). The HR,RR,MAP of group C was higher than that of group D at T 1 time point (P0.05). The difference was statistically significant (P0.05) the HR,MAP of the two groups decreased to T0 level and the RR of group C was lower than that of group T 0 (P0.05). The difference was statistically significant (P0.05). The time and method of sedation and cough score had interaction (P0.05); time comparison, the difference was statistically significant (P0.05); among groups, the difference was statistically significant (P0.05). The sedation score of group C was lower than that of group D at time point C (P0.05). The difference was statistically significant (P0.05) the sedation score of the two groups was higher than that of the T0 point at T3 time point, and the difference was statistically significant (P0.05) the cough score of group C was higher than that of group D at the time point of T1T _ 2 and T _ 3N _ 4, and the difference was statistically significant (P0.05) the score of cough in group C was lower than that in group T _ 0 at T _ 3 time point. The frequency of adding fentanyl in group D (8 times) was less than that in group C (26 times), and the difference was statistically significant (P0.05). Conclusion continuous infusion of dexmetidine can effectively inhibit the cough response of patients with laryngeal cancer during the recovery period of tracheal cannula implantation, maintain hemodynamic stability, analgesia, sedation, and does not affect recovery.
【作者单位】：厦门大学附属第一医院麻醉科;
【分类号】：R614;R739.65

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