摘要
目的:探讨右美托咪定复合地佐辛对腹腔镜胆囊切除患者镇痛的效果及对血浆儿茶酚胺(CA)、内皮素-1(ET-1)的影响。方法:选取本院2017年3月-2019年3月收治的84例行腹腔镜胆囊切除患者,按自愿选择的治疗方式分为对照组和试验组,各42例。试验组进入手术室后静脉滴注1.0μg/kg的右美托咪定,10 min后,以0.5μg/(kg·h)维持至手术结束,手术结束前30 min,静脉滴注0.1 mg地佐辛。对照组只在手术结束前30 min,静脉滴注0.1 mg地佐辛。记录并比较两组在入室后(T0)、麻醉诱导后(T1)、插管后(T2)、胆囊分离时(T3)、手术结束(T4)的心率(HR)和平均动脉压(MAP);比较两组术前1 h和术后1 h血清CA和ET-1水平。比较两组术后3、6、9、12、24 h视觉模拟评分法(visual analogue score,VAS)评分。结果:对照组在T1、T2时的HR与MAP均低于T0,且均低于试验组(P<0.05)。对照组T3、T4时的MAP均低于试验组(P<0.05)。试验组在T1~T4时的HR和MAP与T0比较,差异均无统计学意义(P>0.05)。术后3、6、9、12 h,试验组VAS评分均明显低于对照组(P<0.05)。术后24 h,两组VAS评分比较,差异无统计学意义(P>0.05)。术前1 h,两组血清CA和ET-1水平比较,差异均无统计学意义(P>0.05)。术后1 h,试验组血清CA和ET-1水平均明显低于对照组(P<0.05)。结论:右美托咪定复合地佐辛对腹腔镜胆囊切除患者镇静镇痛效果良好,能够维持循环系统和血流动力学的稳定,降低患者疼痛,改善术后血清CA和ET-1,缓解应激反应,值得进一步应用于临床。
Objective: To investigate the effect of Dexmedetomidine combined with Dezocine on analgesia in patients undergoing laparoscopic cholecystectomy and its effect on plasma catecholamine(CA) and endothelin-1(ET-1). Method: A total of 84 patients undergoing laparoscopic cholecystectomy admitted to our hospital from March 2017 to March 2019 were selected and divided into control group and experimental group according to the treatment method voluntarily selected, 42 cases in each group. The experimental group after entered the operation room, was 1.0 μg/kg of Dexmedetomidine intravenously instilled, after 10 min, maintained at 0.5 μg/(kg·h) until the end of the surgery, at 30 min before the end of the operation, 0.1 mg of Dezocine was intravenously instilled. The control group only at 30 min before the end of the surgery was 0.1 mg of Dezocine intravenously instilled. Heart rate(HR) and mean arterial pressure(MAP) of the two groups were recorded after entered the room(T0), after induction of anesthesia(T1), after intubation(T2), at the time of gallbladder separation(T3), at the end of surgery(T4). Serum CA and ET-1 levels were compared at 1 h before and after surgery. Visual analogue score(VAS) scores were compared at 3, 6, 9, 12 and 24 h after surgery in the two groups. Result: The HR and MAP of the control group at T1 and T2 were lower than those at T0, and lower than those of the experimental group(P<0.05). MAP at T3 and T4 of the control group were lower than those of the experimental group(P<0.05). HR and MAP of the experimental group at T1-T4 were compared with those at T0, the differences were not statistically significant(P>0.05). At 3, 6, 9 and 12 h after surgery, the VAS scores of the experimental group were significantly lower than those of the control group(P<0.05). 24 h after surgery, there were no significant differences in VAS scores between the two groups(P>0.05). 1 h before surgery, there was no significant difference in serum CA and ET-1 levels between the two groups(P>0.05). At 1 h after surgery, serum CA and ET-1 levels in the experimental group were significantly lower than those in the control group(P<0.05). Conclusion: Dexmedetomidine combined with Dezocine has good sedative and analgesic effects in patients undergoing laparoscopic cholecystectomy, it can maintain the stability of circulatory system and hemodynamics, reduce the pain, improve postoperative serum CA and ET-1 and relieve stress response, it is worth further application in the clinic.
作者
邱勇
付云娟
QIU Yong;FU Yunjuan(First People’s Hospital of Fuzhou,Fuzhou 344000,China)
出处
《中国医学创新》
CAS
2019年第32期130-133,共4页
Medical Innovation of China
