目的 观察帕瑞昔布钠联合右美托咪定超前镇痛对乳腺癌改良根治术患者术后镇痛的效果.方法 将拟进行乳腺癌改良根治术患者,依据随机数表法简单二元随机分组,随机分成对照组和试验组.对照组用0.05 mg·kg-1咪达唑仑+1.0～1.5 mg·kg-1丙泊酚+0.4 μg·kg-1枸橼酸舒芬太尼+0.15 mg·kg-1苯磺顺阿曲库铵麻醉诱导及维持方案,试验组在对照组基础上给予帕瑞昔布钠40 mg静脉滴注+右美托咪定0.5 μg·kg-1·h-1持续泵注超前镇痛方案,诱导后5 min气管插管进行机械通气.观察2组患者超前镇痛效果、术后镇静、血流动力学指标、手术改善指标及应用安全性.结果 对照组及试验组分别入组46例.试验组术后6、12及24 h疼痛视觉模拟评分分别为(2.09±0.72)、(4.17±1.07)和(4.07±1.05)分,均低于对照组的(2.61±1.03)、(4.76±1.27)和(4.65±1.11)分,在统计学上差异均有统计学意义(均P＜0.05).试验组与对照组术后6 h Ramsay镇静评分分别为(2.85±0.62)和(2.11±0.73)分,12 h Ramsay 镇静评分分别为(1.41±0.28)和(1.06±0.15)分,24 h 时 Ramsay 镇静评分分别为(1.15±0.18)和(0.64±0.13)分,在统计学上差异均有统计学意义(均P＜0.05).试验组、对照组T2和T3时刻HR、MAP均显著低于T0和T1时刻(均P＜0.05),T2和T3时刻试验组HR、MAP与对照组比较,在统计学上差异均无统计学意义(均P＞0.05).试验组手术时间、术毕苏醒时间、术中失血量均显著少于对照组,在统计学上差异有统计学意义(P＜0.05).试验组和对照组的术后12 h镇痛成功率分别为82.61％(38例/46例)和63.04％(29例/46例),在统计学上差异有统计学意义(P＜0.05).试验组和对照组的药物不良反应主要有心动过缓、头痛、头晕、恶心,试验组和对照组不良反应发生率分别为13.04％(6例/46例)和8.70％(4例/46例),在统计学上差异无统计学意义(P＞0.05).结论 帕瑞昔布钠联合右美托咪定超前镇痛用于乳腺癌改良根治术镇痛及镇静效果均有明显提升,能有效延长镇静、镇痛时间,平稳控制患者围术期血流动力学水平.
Objective To observe the effect of parecoxib sodium combined with dexmedetomidine preemptive analgesia on postoperative analgesia in patients with modified radical mastectomy for breast cancer.Methods Patients who underwent modified radical mastectomy for breast cancer were randomly divided into control group and treatment group based on simple binary randomization by random number table method.In the control group,"0.05 mg·kg-1 midazolam+1.0-1.5 mg·kg-1 propofol+0.4 μg·kg-1sufentanil citrate+0.15 mg·kg-1 phenylsulfonyl cisatracurium"was used for induction and maintenance of anesthesia.In the treatment group,the induction and maintenance of anesthesia was performed with the protocol of"parecoxib sodium 40 mg+dexmedetomidine 0.5 μg·kg-1·h-1)continuous pumping"on the basis of control group,and mechanical ventilation was performed by tracheal intubation 5 min after induction.The effect of pre-analgesia,postoperative sedation,hemodynamic indexes,surgical improvement indexes and application safety were observed by groups.Results There were 46 patients in each group.Pain visual analogue scores at 6,12 and 24 h in treatment group were 2.09±0.72,4.17±1.07 and 4.07±1.05,lower than those in control group,which were 2.61±1.03,4.76±1.27 and 4.65±1.11,the differences were statistically significant(all P＜0.05).The Ramsay sedation scores of the treatment group and the control group at 6 h after surgery were(2.85±0.62)and(2.11±0.73)points,respectively;the sedation scores of Ramsay at 12 h were 1.41±0.28 and 1.06±0.15,respectively.At 24 h,the sedation scores of Ramsay were 1.15±0.18 and 0.64±0.13,respectively,and the difference was statistically significant(P＜0.05).HR and MAP of treatment group and control group at T2 and T3 were significantly lower than those at T1 and T0(P＜0.05),there were no difference in HR and MAP between treatment group and control group at T2 and T3(P＜0.05).Operation time,recovery time after operation and intraoperative blood loss in treatment group were significantly lower than those in control group,and the differences were statistically significant(all P＜0.05).The success rate of 12-hour postoperative analgesia in test group and control group was 82.61％(38 cases/46 cases)and 63.04％(29 cases/46 cases),respectively,and the difference was statistically significant(P＜0.05).The adverse drug reactions in treament group and control group mainly included bradycardia,headache,dizziness and nausea,and the incidence of adverse drug reactions in treatment group and control group were 13.04％(6 cases/46 cases)and 8.70％(4 cases/46 cases),respectively,the difference was no statistically significant(P＜0.05).Conclusion Parecoxib sodium combined with dexmedetomidine preemptive analgesia has significantly improved analgesia and sedative effects in modified radical mastectomy for breast cancer,can prolong sedation and analgesia time,and stably control the perioperative hemodynamics of patients.
赵琦;付莉莉;刘晓云;周广伟;王欣婷;王英
唐山市工人医院麻醉科,河北唐山 063000唐山市工人医院乳腺外科,河北唐山 063000
药学
帕瑞昔布钠;右美托咪定;乳腺癌;超前镇痛;改良根治术
parecoxib sodium;dexmedetomidine;breast cancer;preemptive analgesia;modified radical mastectomy
《中国临床药理学杂志》 2024 (001)
7-11 / 5
10.13699/j.cnki.1001-6821.2024.01.002
评论