摘要
目的探讨右美托咪定联合地佐辛对口腔颌面肿瘤根治胸大肌皮瓣移植术后有创气道管理患者镇静镇痛效果。方法将口腔颌面肿瘤根治胸大肌皮瓣移植术后有创气道管理60例按照随机原则分为右美托咪定组（DE组,20例）、右美托咪定联合地佐辛组（DED组,20例）和等剂量0.9%氯化钠注射液组（C组,20例）。DE组经静脉泵入负荷剂量的右美托咪定0.5μg/kg,10min输注完毕,然后以0.6μg/（kg·h）维持;DED组经静脉泵入负荷剂量的右美托咪定0.5μg/kg,10 min内输注完毕,然后以0.4μg/（kg·h）及地佐辛10μg/（kg·h）同时维持;C组给予同等剂量0.9%氯化钠注射液输注。记录三组患者术前一般情况,观察不同时间心率（HR）、平均动脉压（MAP）、呼气末二氧化碳分压（PetCO2）和Ramsay镇静评分标准评分,并在T4时采用视觉模拟法（VAS）评估疼痛情况。结果三组一般情况及不同时间PetCO2比较差异无统计学意义（P〉0.05）。在T2~T4时,DE组和DED组的HR和MAP显著低于C组（P〈0.05）;在T2时,DE组MAP显著低于DED组（P〈0.05）;在T2和T3时,DE组的HR显著低于DED组（P〈0.05）。在T2~T3时,DE组和DED组的Ramsay评分显著高于C组（P〈0.05）,DED组的Ramsay评分也显著高于DE组（P〈0.05）;在T4时,DE组和DED组的VAS评分显著低于C组（P〈0.05）,DED组的VAS评分也显著低于DE组（P〈0.05）。结论右美托咪定联合地佐辛静脉输注用于口腔颌面肿瘤根治胸大肌皮瓣移植术有创气道管理患者镇静安全、镇痛有效,且能减少右美托咪定用量,减轻其不良反应。
Objective To investigate sedation and analgesic effect of dexmedetomidine given to oral and maxillofacial tumor postoperative patients with tracheostomy tube.Methods Sixty patients after surgical treatment of oral and maxillofacial tumors with tracheostomy tube were randomly divided into dexmedetomidine（DE）group,dexmedetomidine combined with dezocine（DED）group and saline（C）group with 20 patients in each group.DE group was given a loading dose of intravenous infusion of dexmedetomidine at0.5μg/kg,10 min,and then maintained with0.6μg/（kg·h）;DED group received a loading dose of intravenous infusion of dexmedetomidine at 0.5μg/kg,10 min,and then maintained with both dexmedetomidine0.4μg/（kg·h）and dezocine 10μg/（kg·h）;salin（C）group received the same dose of 0.9% sodium chloride.Ramsay score,pain conditions,heart rate,blood pressure,respiratory and other changes were compared among 3 groups before administration（T0）,30 minutes after administration（T1）,6 hours after administration（T2）,12 hours after administration（T3）and 24 hours after administration（T4）.The data was processed with SPSS 17.0software package.Results There was no significant difference for ETCO2 among the three groups at all time points（P〉0.05）.At T2~T3,Ramsay score of DE group and DED group was significantly higher than saline（C）group（P〈0.05）.Ramsay score of DED group was significantly higher than DE group（P〈0.05）.At T4,VAS score of DE group and DED group was significantly lower than saline（C）group（P〈0.05）,and it was significantly lower in DED group than that in DE group（P〈0.05）.Conclusions Dexmedetomidine combined with dezocine used in postoperative oral and maxillofacial tumor patients who reconstructed by PMMF with traumatic airway management is safe and effective for sedation and analgesia.It can reduce the dose of dexmedetomidine and rate of adverse recation.
出处
《中国煤炭工业医学杂志》
2016年第4期505-508,共4页
Chinese Journal of Coal Industry Medicine
基金
上海市自然科学基金项目(编号:11ZR1448600)
关键词
口腔颌面肿瘤根治术
胸大肌皮瓣移植术
右美托咪定
地佐辛
镇静
镇痛
Oral and maxillofacial tumor
Pectoralis major myocutaneous flap
Sedation
Analgesic
Dexmedetomidine
Dezocine
