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目的研究右美托咪定联合雷米芬太尼用于食道癌根治术术后自控镇痛的效果及安全性。方法本研究选择食道癌根治术患者40例,随机均分为两组(n=20):A组:右美托咪定0.4μg·kg~(-1)·h~(-1)+雷米芬太尼0.05μg·kg~(-1)·h~(-1)加0.9%氯化钠溶液共100ml入泵;B组:雷米芬太尼0.05μg·kg~(-1)·h~(-1)+0.9%氯化钠溶液共100ml入泵。两组患者均采用静脉自控镇痛,每次自控给药量0.5ml,锁定时间15min。记录两组患者术后2、6、12、24及48h患者静息和咳嗽时的VAS疼痛评分和Ramsay镇静评分、不良反应及镇痛不全例数。结果两组患者一般资料差异均无统计学意义(P>0.05)。与B组比较,A组术后不同时点的静息和体动时VAS评分均降低(P<0.05)、Ramsay评分差异无统计学意义(P>0.05)。B组术后48h内PCA有效按压次数高于A组(P<0.05),两组苏醒时间差异无统计学意义(P>0.05);A组术后胸腹部不适感、恶心呕吐、嗜睡和皮肤瘙痒,镇痛不全等不良反应的发生率降低(P<0.05),心动过缓、低血压及呼吸抑制等差异无统计学意义(P>0.05)。结论右美托咪定联合雷米芬太尼用于食道癌根治术静脉自控镇痛效果满意,不良反应少,安全可靠,显著改善患者术后的舒适度。
Objective To study the efficacy and safety of dexmedetomidine combined with remifentanil in controlled postoperative analgesia of esophageal cancer. Methods Forty patients undergoing radical resection of esophageal cancer were randomly divided into two groups (n = 20): group A: dexmedetomidine 0.4 μg · kg -1 · h -1 The rats in the group were injected with 100ml of 0.05μg · kg -1 h -1 of mifepristone plus 0.9% sodium chloride solution, Group B 0.05mg · kg -1 of remifentanil h ~ (-1) + 0.9% sodium chloride solution a total of 100ml into the pump. Two groups of patients were used intravenous analgesia, each controlled dose 0.5ml, lock time 15min. The VAS pain score, Ramsay sedation score, adverse reactions and the number of cases of incomplete analgesia were recorded at 2, 6, 12, 24 and 48 hours after operation in both groups. Results There was no significant difference in general data between the two groups (P> 0.05). Compared with group B, the VAS scores of rest and body movement in group A were decreased at different time points after operation (P <0.05). There was no significant difference in Ramsay score between two groups (P> 0.05). The effective pressure of PCA was significantly higher in group B than in group A within 48 hours after operation (P <0.05), and there was no significant difference in recovery time between the two groups (P> 0.05). The postoperative thoracoabdominal discomfort, nausea and vomiting, lethargy and skin (P <0.05), mild bradycardia, hypotension and respiratory depression, the difference was not statistically significant (P> 0.05). Conclusion Dexmedetomidine combined with remifentanil for esophageal cancer radical vein controlled analgesia with satisfactory results, fewer adverse reactions, safe and reliable, significantly improve postoperative comfort.