摘要
目的 分析右美托咪定复合舒芬太尼自控静脉镇痛对阴式子宫切除术患者术后应激及疼痛状态的影响.方法 选择102例阴式子宫切除术患者为研究对象,随机分为联合组(给予右美托咪定复合舒芬太尼自控镇痛)和对照组(给予舒芬太尼自控镇痛)各51 例.比较两组术毕(T0)、术后2 h(T1)、术后6 h(T2)、术后12 h(T3)、术后24 h(T4)的血流动力学指标[心率(HR)、氧饱和度(SpO2)、平均动脉压(MAP)]、自控静脉镇痛(PCIA)次数、应激反应指标[促肾上腺皮质激素(ACTH)、皮质醇(Cor)、醛固酮(ALD)、白介素-6(IL-6)],T0、T4时段的疼痛因子[β内啡肽(β-EP)、血清P物质(SP)、神经肽Y(NPY)]水平、视觉模拟评分(VAS)以及不良反应.结果 T2时,联合组HR和MAP低于对照组(t分别=2.27、6.05,P均＜0.05),T3、T4 时,联合组HR高于对照组,MAP低于对照组(t分别=-2.22、-4.90;2.78、2.55,P均＜0.05);T2～T4时,SpO2水平高于对照组(t分别=-18.06、-6.93、-6.29,P＜0.05);联合组PCIA总次数少于对照组(t=2.27,P＜0.05);T1～T4 时,联合组ACTH、Cor、ALD水平均低于对照组(t分别=21.75、38.55、41.42;41.91、2.12、2.60、5.80;5.75,4.26、5.91、7.51、20.01,P均＜0.05),T3、T4时,联合组IL-6水平低于对照组(t分别=4.68、13.20,P均＜0.05);T4时,联合组β-EP、SP和NPY水平均低于对照组(t分别=10.91、12.53、12.34,P均＜0.05);T1～T4时,联合组VAS评分均低于对照组(t分别=2.82、4.59、13.77、11.01,P均＜0.05);联合组术后不良反应总发生率与对照组比较,差异无统计学意义(χ2=0.64,P＞0.05).结论 右美托咪定复合舒芬太尼自控静脉镇痛有利于改善阴式子宫切除术患者术后应激指标和稳定血流动力学指标,迅速有效地缓解疼痛,且不良反应发生风险较低.
Abstract
Objective To analyze the influence of dexmetomidine combined with sufentanil for patient-controlled intra-venous analgesia on postoperative stress and pain status in patients with vaginal hysterectomy.Methods A total of 102 patients with vaginal hysterectomy were selected as the study subjects and randomly divided into combined group(dex-medetomidine combined with sufentanil patient-controlled analgesia,51 cases)and control group(sufentanil patient-con-trolled analgesia,51 cases).The hemodynamic indicators[heart rate(HR),oxygen saturation(SpO2),mean arterial pres-sure(MAP)],patient-controlled intravenous analgesia(PCIA)frequency and stress response indicators[adrenocortico-tropic hormone(ACTH),cortisol(Cor),aldosterone(ALD),interleukin-6(IL-6)]after the end of surgery(T0),2 hours(T1),6 hours(T2),12 hours(T3)and 24 hours after surgery(T4),levels of pain factors[β endorphin(β-EP),serum substance P(SP),neuropeptide Y(NPY)],visual analogue score(VAS)and adverse reactions at T0 and T4 were compared between the two groups.Re-sults At T2,the HR and MAP in combined group were lower than those in control group(t=2.27,6.05,P＜0.05),and HR at T3 and T4 were higher than those in control group,MAP were lower than those in the control group(t=-2.22,-4.90,2.78,2.55,P＜0.05).The SpO2 in combined group was higher than that in control group at T2,T3,T4(t=-18.06,-6.93,-6.29,P＜0.05).The total PCIA frequency in combined group was less than that in control group(t=2.27,P＜0.05).The levels of ACTH,Cor and ALD at T1,T2,T3,T4 were lower in combined group than those in control group(t=21.75,38.55,41.42,41.91,2.12,2.60,5.80,5.75,4.26,5.91,7.51,20.01,P＜0.05),and the level of IL-6 in combined group at T3 and T4 was lower than that in control group(t=4.68,13.20,P＜0.05).The levels of β-EP,SP and NPY in combined group were lower than those in control group at T4(t=10.91,12.53,12.34,P＜0.05).The VAS score in combined group was lower compared with that in control group at T1,T2,T3,T4(t=2.82,4.59,13.77,11.01,P＜0.05).The total incidence rate of adverse reactions between two groups was not statistically different(χ2=0.64,P＞0.05).Conclusion Patient-controlled intravenous analgesia with dexmedetomidine combined with sufentanil can help to improve the postoperative stress indicators,stabilize the hemodynamic indicators,and relieve the pain quickly and effectively in patients with vaginal hysterectomy,and it has a low risk of adverse reactions.
基金项目
2022年度金华市公益性技术应用研究项目(2022-4-333)
维普
万方数据