【摘要】：目的:1.研究右美托咪定對(duì)直腸癌根治術(shù)患者氟比洛芬酯多模式鎮(zhèn)痛效果的影響。2.評(píng)價(jià)右美托咪定對(duì)直腸癌根治術(shù)患者氟比洛芬酯多模式鎮(zhèn)靜效果的影響。3.探討右美托咪定對(duì)氟比洛芬酯多模式鎮(zhèn)痛患者應(yīng)激反應(yīng)和炎癥反應(yīng)的影響。4.討論右美托咪定對(duì)氟比洛芬酯多模式鎮(zhèn)痛患者不良反應(yīng)的影響。方法:選取2016年1月至2016年5月于天津醫(yī)科大學(xué)腫瘤醫(yī)院擇期行直腸癌切除術(shù)的腫瘤患者共90例,隨機(jī)分為3組,每組30例。A、B兩組手術(shù)開始前30min緩慢靜脈滴注氟比洛芬酯1mg/kg行超前鎮(zhèn)痛,C組為對(duì)照組,手術(shù)開始前30min緩慢靜脈滴注5ml脂肪乳。麻醉誘導(dǎo):依次靜注咪達(dá)唑侖0.03mg/kg、舒芬太尼0.3μg/kg、丙泊酚2mg/kg、羅庫溴銨0.6mg/kg,充分去氮給氧后行氣管插管操作,連接麻醉機(jī)控制呼吸,調(diào)整呼吸參數(shù)并維持氣道壓≤20cm H2O、PETCO2 35~45 mm Hg。麻醉維持:術(shù)中恒速輸注丙泊酚、瑞芬太尼維持麻醉深度,保持BIS值40~60。術(shù)畢送往麻醉蘇醒室觀察,留觀30min時(shí)監(jiān)測(cè)患者術(shù)后血糖,待患者各項(xiàng)指標(biāo)符合相應(yīng)標(biāo)準(zhǔn)后送返病房。術(shù)后患者靜脈自控鎮(zhèn)痛泵配制方法:A組(右美托咪定聯(lián)合氟比洛芬酯多模式鎮(zhèn)痛組)右美托咪定2μg/kg+氟比洛芬酯2mg/kg+舒芬太尼2μg/kg;B組(氟比洛芬酯多模式鎮(zhèn)痛組)氟比洛芬酯2mg/kg+舒芬太尼2μg/kg;C組(對(duì)照組)舒芬太尼2μg/kg+脂肪乳10ml;三組均加生理鹽水至100ml。鎮(zhèn)痛泵流速1ml/h,單次按壓量1ml,鎖定時(shí)間15min。分別記錄術(shù)后4h(T1)、8h(T2)、12h(T3)、24h(T4)、48h(T5)各時(shí)間點(diǎn)咳嗽時(shí)疼痛視覺模擬評(píng)分(VAS)以及Ramsay鎮(zhèn)靜評(píng)分;記錄術(shù)后24h內(nèi)患者自控靜脈鎮(zhèn)痛泵有效按壓次數(shù)及舒芬太尼用藥量;記錄術(shù)前及術(shù)后30min血糖、術(shù)前及術(shù)后48h內(nèi)C反應(yīng)蛋白(C-reactive protein,CRP);觀察術(shù)后48h內(nèi)加強(qiáng)鎮(zhèn)痛例數(shù)及不良反應(yīng)(惡心嘔吐、頭暈頭痛、皮膚瘙癢、尿潴留、呼吸抑制、心動(dòng)過緩等)例數(shù)。結(jié)果:1.A組T1、T2、T3咳嗽時(shí)VAS評(píng)分明顯小于B、C兩組(P0.05)。A組24h內(nèi)止疼泵有效按壓次數(shù)、舒芬太尼用藥量明顯小于B、C兩組(P0.05)。三組加強(qiáng)鎮(zhèn)痛例數(shù)差異無統(tǒng)計(jì)學(xué)意義。2.A組T1、T2時(shí)Ramsay鎮(zhèn)靜評(píng)分高于B、C組(P0.05)。3.A組術(shù)后30min血糖和術(shù)后48h CRP明顯小于B、C兩組(P0.05)。4.A、B兩組間不良反應(yīng)例數(shù)無統(tǒng)計(jì)學(xué)意義且均低于C兩組(P0.05)。結(jié)論:右美托咪定聯(lián)合氟比洛芬酯多模式鎮(zhèn)痛用于直腸癌根治術(shù)患者,可增強(qiáng)其鎮(zhèn)痛、鎮(zhèn)靜效果,減少應(yīng)激和炎癥反應(yīng),降低不良反應(yīng)的發(fā)生風(fēng)險(xiǎn)。
[Abstract]:Objective: 1. To study the effect of dexmetiomide on multimode analgesia of flavibiprofen ester in patients undergoing radical resection of rectal cancer. 2. To evaluate the effect of dexmetiomide on multimode sedation of fluorobiprofen ester in patients undergoing radical resection of rectal cancer. 3. To investigate the effect of dexmetiomide on stress response and inflammatory response in patients with flavibiprofen multimode analgesia. 4. To discuss the effect of dexmetiomide on adverse reactions in patients with flavibiprofen multimode analgesia. Methods: from January 2016 to May 2016, 90 patients with rectal cancer were randomly divided into 3 groups with 30 patients in each group. Group A and group B underwent preemptive analgesia with slow intravenous drip of flubiprofen ester 1mg/kg before the beginning of the operation, while group C was the control group. 30min was slowly infused with 5ml fat emulsion before the beginning of the operation. Anesthesia induction: intravenous injection of midazolam 0.03 mg 路kg ~ (- 1), sufentanil 0.3 渭 g / kg, propofol 2 mg 路kg ~ (- 1), rocuronium 0.6 mg 路kg ~ (- 1), trachea intubation after full denitrification and oxygen supply, connecting anesthetic machine to control respiration, adjusting respiratory parameters and maintaining airway pressure 鈮，

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