盐酸右美托咪定在瓣膜置换手术患者术后并发症防治的应用
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摘要
观察心脏外科术后患者应用盐酸右美托咪定(dexmedetomidine hydrochloride,DEX)对术后并发症的防治效果。方法选取2015年1月至2016年3月哈尔滨医科大学附属第二临床医学院60例行瓣膜置换手术的患者,随机分为对照组(C组)、DEX组(D组),每组30例。两组患者术后由心外科监护室转入心外科病房术后观察室后给予基础治疗的同时,均于晚间行镇静镇痛治疗,C组于每晚21:00应用盐酸哌替啶(1 mg/kg)+盐酸异丙嗪(25 mg)肌肉注射,D组于每晚20:00应用微量输液泵恒速输注DEX(0.7μg·kg~(-1)·h~(-1)),至次日06:00停止输注,上述治疗方案连用3 d。记录2组患者应用镇痛镇静治疗前后的生命体征、术后恶心呕吐(postoperativenausea and vomiting,PONV)发生情况及次数、术后严重疼痛情况、术后心房颤动发生情况以及术后不良反应发生情况。结果 D组在D1时间点的疼痛评分明显低于C组相同时间点,差异有统计学意义(P<0.05);D组在D1、D2时间点的PONV发生率均明显低于C组相同时间点,差异有统计学意义(P<0.05);D组术后严重疼痛的发生率明显低于C组,差异有统计学意义(P<0.05);D组术后快速心房颤动发生率明显低于C组,差异有统计学意义(P<0.05)。结论 DEX用于心脏外科术后镇静镇痛安全有效,能减少患者PONV及快速心房颤动的发生率,有利于患者术后康复。
Objectives To observe the effect of dexmedetomidine hydrochloride(DEX)on postoperative complicationsin patients undergoing cardiac surgery. Methods Sixty patients undergoing valve replacement from January 2015 toMarch 2016 in The Second Affiliated Hospital of Harbin Medical University were randomly divided into control group(C group)and DEX group(D group),30 cases in each group. Patients in both groups were treated with sedative andanalgesic therapy at night. Patients in C group were treated with pethidine hydrochloride(1 mg/kg)+ promethazinehydrochloride(25 mg)at 21:00 every night intramuscularly;Patients in D group were treated by suing a small infu-sion pump constant infusion of DEX(0.7 μg · kg~(-1)·h~(-1))at 20:00 every night and at 6:00 the next day they werestopped infusion. Treatment plan was 3 days. Vital signs,incidence and frequency of postoperative nausea and vomiting(PONV),postoperative pain,postoperative atrial fibrillation(AF)and incidence of adverse events after operationwere recorded in the 2 groups. Results Pain scores of D group at the time point of D1 were significantly lower thanthose of C group at the same time point(P<0.05). Incidences of PONV in D group at the time point of D1,D2 were significantly lower than those in C group at the same time points(P<0.05). Incidence of severe postoperative pain in Dgroup was significantly lower than that in C group(P<0.05),and incidence of rapid AF in D group was significantlylower than that in C group(P<0.05). Conclusions DEX is safe and effective for sedation and analgesia after cardiacsurgery. It can reduce the incidence of PONV and rapid AF in patients after cardiac surgery.
Objectives To observe the effect of dexmedetomidine hydrochloride(DEX)on postoperative complicationsin patients undergoing cardiac surgery. Methods Sixty patients undergoing valve replacement from January 2015 toMarch 2016 in The Second Affiliated Hospital of Harbin Medical University were randomly divided into control group(C group)and DEX group(D group),30 cases in each group. Patients in both groups were treated with sedative andanalgesic therapy at night. Patients in C group were treated with pethidine hydrochloride(1 mg/kg)+ promethazinehydrochloride(25 mg)at 21:00 every night intramuscularly;Patients in D group were treated by suing a small infu-sion pump constant infusion of DEX(0.7 μg · kg~(-1)·h~(-1))at 20:00 every night and at 6:00 the next day they werestopped infusion. Treatment plan was 3 days. Vital signs,incidence and frequency of postoperative nausea and vomiting(PONV),postoperative pain,postoperative atrial fibrillation(AF)and incidence of adverse events after operationwere recorded in the 2 groups. Results Pain scores of D group at the time point of D1 were significantly lower thanthose of C group at the same time point(P<0.05). Incidences of PONV in D group at the time point of D1,D2 were significantly lower than those in C group at the same time points(P<0.05). Incidence of severe postoperative pain in Dgroup was significantly lower than that in C group(P<0.05),and incidence of rapid AF in D group was significantlylower than that in C group(P<0.05). Conclusions DEX is safe and effective for sedation and analgesia after cardiacsurgery. It can reduce the incidence of PONV and rapid AF in patients after cardiac surgery.
引文
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[14]张媛,谭晓明,常惠礼.右美托咪定对脂多糖诱导HLF细胞凋亡的影响[J].今日药学,2017,27(12):793-795.
[15]徐建国,吴新民,罗爱伦,等.成人术后疼痛处理专家共识[J].临床麻醉学杂志,2010,26(3):190-196.
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[17]CHRYSOSTOMOU C,SANCHEZDETOLEDO J,WEARDEN P,et al.Perioperative use of dexmedetomidine is associated with decreased incidence of ventricular and supraventricular tachyarrhythmias after congenital cardiac operations[J].Ann Thor Surg,2011,92(3):964-972.
[2]THUNE A,APPELGREN L,HAGLIND E.Prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy.A prospective randomized study of metoclopramide and transdermal hyoscine[J].Eur J Surg,1995,161(4):265-268.
[3]WILLIAM H.Atrial fibrillation after cardiac surgery[J].Ann Intern Med,2001,135(12):1061-1073.
[4]DONG X,XING Q,LI Y,et al.Dexmedetomidine protects against ischemia-reperfusion injury in rat skeletal muscle[J].J Surg Res,2013,186(1):240-245.
[5]徐斐.围术期应用盐酸右美托咪定对心脏手术患者预后影响的研究[D].北京协和医学院,2015.
[6]王晓武.快速康复医学在心脏外科中的应用及前景展望[J].实用医学杂志,2012,28(1):10-12.
[7]江志伟,李宁,黎介寿.快速康复外科的概念及临床意义[J].中国实用外科杂志,2007,27(2):131-133.
[8]苏玉池,李罡.右美托咪啶临床应用研究进展[J].实用临床医学,2014,15(9):130-133.
[9]SHIN H W,YOO H N,KIM D H,et al.Preanesthetic dexmedetomidine 1μg/kg single infusion is a simple,easy,and economic adjuvant for general anesthesia[J].Korean J Anesthesiol,2013,65(2):114-120.
[10]ROBINSON S L,FELL D.Nausea and vomiting with use of a patient-controlled analgesia system[J].Anaesthesia,1991,46(7):580-582.
[11]YAMADA Y,FUJITA M,OKUYAMA K,et al.Analysis of antiemetic effect of various dosage regimens of azasetron hydrochloride based on 5-HT3 receptor occupancy of serotonin[J].Yakugaku Zasshi,2007,127(2):353-357.
[12]SICHROVSKY T C,MITTAL S,STEINBERG J S.Dexmedetomidine sedation leading to refractory cardiogenic shock[J].Anesth Analg,2008,106(6):1784-1786.
[13]ODDBY-MUHRBECK E,EKSBORG S,BERGENDAHL H T,et al.Effects of clonidine on postoperative nausea and vomiting in breast cancer surgery[J].Anesthesiol,2002,96(5):1109-1114.
[14]张媛,谭晓明,常惠礼.右美托咪定对脂多糖诱导HLF细胞凋亡的影响[J].今日药学,2017,27(12):793-795.
[15]徐建国,吴新民,罗爱伦,等.成人术后疼痛处理专家共识[J].临床麻醉学杂志,2010,26(3):190-196.
[16]BURGESS D C,KILBORN M J,KEECH A C.Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery:a meta-analysis[J].Eur Heart J,2006,27(23):2846-2857.
[17]CHRYSOSTOMOU C,SANCHEZDETOLEDO J,WEARDEN P,et al.Perioperative use of dexmedetomidine is associated with decreased incidence of ventricular and supraventricular tachyarrhythmias after congenital cardiac operations[J].Ann Thor Surg,2011,92(3):964-972.