右美托咪定复合盐酸羟考酮术后镇痛对胃肠肿瘤病人睡眠质量的影响

doi:10.12092/j.issn.1009-2501.2018.02.009

中国临床药理学与治疗学 ›› 2018, Vol. 23 ›› Issue (2): 165-169.doi: 10.12092/j.issn.1009-2501.2018.02.009

右美托咪定复合盐酸羟考酮术后镇痛对胃肠肿瘤病人睡眠质量的影响

王俊¹，蒋宗明²，郑君刚¹，曹刚¹，黄长顺¹，卢子会¹，季一勤¹

¹宁波市第一医院麻醉科，宁波 315010，浙江；²绍兴市人民医院麻醉科，绍兴 312000，浙江

收稿日期:2017-11-02 修回日期:2017-12-18 出版日期:2018-02-26 发布日期:2018-03-02
通讯作者: 黄长顺，男，主任医师，硕士生导师，研究方向：临床麻醉、疼痛诊疗、疑难危重症处理。 Tel：0574-87085084 E-mail：nbhcs1967@163.com
作者简介:王俊，男，硕士，主治医师，研究方向：临床麻醉及危重症处理。 E-mail：180446184@qq.com
基金资助:
浙江省绍兴市卫计委青年科技计划（2016QN004）；浙江省医学会临床科研基金项目（2015ZYC-A51）

Effects of oxycodone hydrochloride combined with dexmedetomidine postoperative analgesia on sleep quality of patients with gastrointestinal tumors

WANG Jun ¹, JIANG Zongming ², ZHENG Jungang ¹, CAO Gang¹, HUANG Changshun¹, LU Zihui¹, JI Yiqin¹

¹Department of Anesthesia, First Hospital of Ningbo, Ningbo 315010, Zhejiang, China;²Department of Anesthesia, People Hospital of Shaoxing, Shaoxing 312000, Zhejiang, China

Received:2017-11-02 Revised:2017-12-18 Online:2018-02-26 Published:2018-03-02

摘要/Abstract

摘要：

目的: 评价右美托咪定（dexmedetomidine,DEX）复合盐酸羟考酮术后患者自控静脉镇痛对胃肠肿瘤手术病人睡眠质量的影响。方法: 择期行腹腔镜下胃肠肿瘤根治术病人60例，年龄49～74岁，ASA分级Ⅰ～Ⅱ级，BMI 17～24 kg/m2，性别不限。采用随机数字表法分为3组（n=20）：盐酸羟考酮组（O组）、小剂量DEX复合羟考酮组（D1组）和大剂量DEX复合羟考酮组（D2组）。静脉输注泵术后镇痛（PCIA）方案：O组盐酸羟考酮50 mg，0.9%生理盐水稀释至100 mL，背景剂量2 mL/h，单次给药剂量0.5 mL，锁定时间15 min；D1组在O组方案基础上于PCIA泵中加入0.05 μg·kg-1·h-1 DEX；D2组在O组方案基础上于PCIA泵中加入0.1 μg·kg-1·h-1 DEX。麻醉恢复室（PACU）期间维持VAS评分不高于4分。多导睡眠仪监测术前1晚（T0）、术后第1晚（T1）和术后第2晚（T2）的睡眠效率指数（sleep efficiency index,SEI）、觉醒指数（arousal index,AI）及快眼动睡眠（rapid eye-movement,REM）占总睡眠时间的百分比；记录术后低血压、心动过缓、嗜睡、头晕、呕吐不良反应的发生率及病人满意度。结果: 与T0时点比较，3组T1时点SEI降低、AI升高，T2时点O组SEI降低、AI升高（P<0.05）；与O组比较，T1和T2时点D1组、D2组SEI升高、AI降低（P<0.05）；与O组比较，D1组、D2组低血压发生率及病人满意度高、总呕吐发生率低（P<0.05）；与D1组比较，D2组低血压、心动过缓、嗜睡发生率高（P<0.05）。结论:小剂量DEX复合盐酸羟考酮术后患者自控静脉镇痛可显著改善胃肠肿瘤手术病人睡眠质量，不良反应更少，病人满意度高。

关键词: 右美托咪定, 盐酸羟考酮, 睡眠质量, 镇痛

Abstract:

AIM: To evaluate the effects of hydrochloride oxycodone combined with dexmedetomidine postoperative analgesia on sleep quality of patients with gastrointestinal tumors. METHODS: Sixty ASA Ⅰ or Ⅱ patients aged 49-74 year with BMI of 17-24 kg/m2 undergoing laparoscopic resection of gastrointestinal tumors were randomly divided into 3 groups (n=20 in each group): group Ⅰ oxycodone (group O) , dexmedetomidine 0.05 μg·kg^-1·h^-1 combined with oxycodone group (group D1), dexmedetomidine 0.1 μg·kg^-1·h^-1 combined with oxycodone group (group D2). In O, D1, and D2 groups, the PCIA solution contained oxycodone 50 mg, oxycodone 50 mg plus dexmedetomidine 0.05 μg·kg^-1·h^-1, and oxycodone 50 mg plus dexmedetomidine 0.1 μg·kg^-1·h^-1 in 100 mL of 0.9% normal saline, respectively. The PCIA pump was set up to deliver a 0.5 mL bolus dose with a 15-min lockout interval and background infusion at 2 mL/h. VAS score was maintained ≤4. Polysomnography measures were performed the night before surgery (T0), the first night after surgery (T1), and the second night after surgery (T2), and recorded the sleep efficiency index (SEI), arousal index (AI), the percent of rapid eye-movement(REM). Patients' satisfaction and the occurrence of adverse reactions such as hypotension, bradycardia, somnolence, dizziness, vomiting were also recorded. RESULTS: Compared with T0, SEI were significantly decreased and AI were significantly increased in T1 of three groups and T2 of group O (P<0.05); Compared with group O, SEI were significantly increased and AI were significantly decreased in group D1 and D2 (P<0.05), the patients' satisfaction and the occurrence of hypotension were significantly increased, the occurrence of vomiting was significantly decreased (P<0.05); Compared with group D1, the occurrence of hypotension, bradycardia, somnolence was significantly increased in group D2 (P<0.05). CONCLUSION: Postoperative analgesia with small dose of dexmedetomidine combined with oxycodone hydrochloride can significantly improve the sleep quality of patients with gastrointestinal tumors, with fewer occurrence of hypotension and better patients' satisfaction.

Key words: dexmedetomidine, hydrochloride oxycodone, sleep quality, analgesia

中图分类号:

R614

王俊，蒋宗明，郑君刚，曹刚，黄长顺，卢子会，季一勤. 右美托咪定复合盐酸羟考酮术后镇痛对胃肠肿瘤病人睡眠质量的影响[J]. 中国临床药理学与治疗学, 2018, 23(2): 165-169.

WANG Jun, JIANG Zongming, ZHENG Jungang, CAO Gang, HUANG Changshun, LU Zihui, JI Yiqin. Effects of oxycodone hydrochloride combined with dexmedetomidine postoperative analgesia on sleep quality of patients with gastrointestinal tumors[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2018, 23(2): 165-169.

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右美托咪定复合盐酸羟考酮术后镇痛对胃肠肿瘤病人睡眠质量的影响

Effects of oxycodone hydrochloride combined with dexmedetomidine postoperative analgesia on sleep quality of patients with gastrointestinal tumors

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