同济大学学报（医学版）2018，Vol.39Issue(3)：79-83,5.DOI:10.16118/j.1008-0392.2018.03.015
右美托咪定对电视辅助胸腔镜手术肺叶切除后镇痛效果的影响
Effect of dexmedetomidine on postoperative analgesia in patients undergoing video assisted thoracoscopic lobectomy
摘要
Abstract
Objective To determine the effects of dexmedetomidine on postoperative analgesia in patients undergoing video-assisted thoracoscopic ( VATS) lobectomy. Methods Eighty-three patients of ASA gradeⅠ-Ⅲ undergoing VATS unilateral lobectomy were randomly assigned into two groups:sufentanil group (group S, n＝42) and dexmedetomidine combined with sufentanil group (group SY, n＝41). Two groups received the same rapid intravenous anesthesia induction program, maintaining with remifentanil 4-5 μg/(kg·h) and 2%-4%sevoflurane, rocuronium was added on time and on demand. At the same time, dexmedetomidine hydrochloride 0. 01 μg/( kg·min) was injected with micropump after the induction of anesthesia in group SY.dexmedetomidine did not give a load dose direct continuous pump to the end of the operation. In group SY 200 μg dexmedetomidine was added to postoperative patient-controlled analgesia (PCA) infusion pump on the basis of group S and sulfentanyl was reduced by 50 μg simultaneously.The VAS pain scores and Ramsay sedation score were applied for evaluation at 4(T1), 8(T2), 12(T3), 24(T4) and 48 h(T5)after surgery. The times of PCA pump use within 48 h after surgery and the incidence of adverse events were documented. Results There were significant differences in VASR and VASC at all time points except T5of VASR after operation between two groups (P＜0. 05). There was significant difference in the effective PCA pump press times at time points T1, T2 and T3after operation ( P＜0. 05). There were significant differences in the incidence of postoperative complications including heart rate changes, abnormal blood pressure changes, nausea and vomiting, respiratory depression, atelectasis, pulmonary infection, and as well as postoperative hospitalization days between two groups (P＜0. 05).Conclusion Dexmedetomidine can enhance the analgesic effect, reduce the side effects of sufentanil, reduce postoperative pulmonary complications and promote postoperative recovery for patients undergoing VATS pulmonary lobectomy.关键词
右美托咪定/胸腔镜/肺叶切除术/术后镇痛Key words
dexmedetomidine/thoracoscopy/lobectomy/postoperative analgesia分类
医药卫生引用本文复制引用
成熙芸,魏娟,罗晶,程志军,尤新民,吕欣..右美托咪定对电视辅助胸腔镜手术肺叶切除后镇痛效果的影响[J].同济大学学报（医学版）,2018,39(3):79-83,5.基金项目
上海市科委引导项目(14401932500) （14401932500）
上海市科委产学研医合作项目(16DZ1930307) （16DZ1930307）
