摘要： 目的 探讨右美托咪定（DEX）联合酮咯酸氨丁三醇和酒石酸布托啡诺静脉自控镇痛（PCIA）对胸腔镜下肺癌根治术患者术后睡眠质量的影响。方法 选择择期行胸腔镜下肺癌根治术患者83例，ASA Ⅰ~Ⅱ级，年龄28~68岁，随机分为DEX+酒石酸布托啡诺+酮铬酸氨丁三醇组（DBK组，35例）和DEX+酮咯酸氨丁三醇组（DK组，48例）。PCIA方案：DBK组给予DEX[0.05 μg/（kg·h）]、酒石酸布托啡诺（0.05 mg/kg）、酮咯酸氨丁三醇（2 mg/kg）、帕洛诺司琼（0.5 mg）；DK组给予DEX[0.1 μg/（kg·h）]、酮咯酸氨丁三醇（3 mg/kg）、帕洛诺司琼（0.5 mg）。术后镇痛时间48 h。记录2组患者术前，术后1 d、2 d夜间最大静息和活动后视觉模拟评分（VAS），术后48 h PCIA按压总次数及有效次数、术后1 d、2 d夜间PCIA按压总次数及有效次数；记录术前，术后1 d、2 d患者匹兹堡睡眠质量指数（PSQI）、夜间觉醒次数及其原因；记录术后不良反应的发生情况。结果 与术前比较，2组患者术后1 d、2 d夜间最大静息和活动后VAS均显著增加（均P < 0.05）。与DK组比较，DBK组患者术后2 d夜间最大静息VAS和活动后VAS显著减少（P < 0.05）。2组患者PCIA按压次数均无统计学差异（P > 0.05）。与术前比较，2组术后1 d、2 d夜间觉醒次数显著增加（P < 0.05）；夜间睡眠总时间显著减少（P < 0.05），入睡时间显著延长（P < 0.05），PSQI和主观睡眠质量评分显著增高（P < 0.05）。与DK组比较，DBK组术后2 d主观睡眠质量评分显著减少（P < 0.05），入睡时间显著缩短（P < 0.05）。结论 DEX复合酒石酸布托啡诺和酮铬酸氨丁三醇用于术后PCIA，对胸腔镜下肺癌根治术患者可提供满意的镇痛效果，改善患者术后睡眠质量。

右美托咪定复合不同镇痛药物静脉自控镇痛对胸腔镜下肺癌根治术患者术后睡眠质量的影响

逯欣宇¹, 苗壮¹, 杨昕², 侯千暠², 周发忱³, 闻庆平¹

1. 大连医科大学附属第一医院麻醉科, 辽宁 大连 116011;
2. 大连医科大学麻醉学系, 辽宁 大连 116000;
3. 大连医科大学附属第一医院胸外科, 辽宁 大连 116011

收稿日期:2019-11-06出版日期:2020-08-30发布日期:2020-08-04
通讯作者:苗壮E-mail:18098876195@163.com
作者简介:逯欣宇(1986-),女,主治医师,硕士研究生.
基金资助:辽宁省自然科学基金（20180551083）


关键词: 右美托咪定, 酒石酸布托啡诺, 酮咯酸氨丁三醇, 静脉自控镇痛, 睡眠
Abstract: Objective To investigate the effect of patient-controlled intravenous analgesia (PCIA) with dexmedetomidine (DEX) and ketorolac tromethamine (KET) and/or butorphanol tartrate (BUT) on post-operative sleep quality in patients undergoing thoracoscopic radical resection of lung cancer. Methods A total of 83 patients,aged 28 to 68 years,with the American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ undergoing thoracoscopic radical resection of lung cancer,were chosen and divided into two groups:the DBK group (n=35) and the DK group (n=48). The PCIA protocol in the DBK group was DEX 0.05 μg/(kg·h),BUT 0.05 mg/kg,KET 2 mg/kg and palonosetron 0.5 mg and in the DK group was DEX 0.1 μg/(kg·h),KET 3 mg/kg and palonosetron 0.5 mg. The analgesic time was 48 h. The resting and coughing visual analog scores (VAS) were recorded before surgery and on the first and second days after surgery. The total and effective PCIA pressing frequencies within 48 h after surgery and the nighttime frequencies were also recorded. The Pittsburgh sleep quality indexes (PSQI),frequencies,and causes of nighttime awakening were recorded before surgery and on the first and second days after surgery. The adverse events were also recorded. Results Compared with the VAS before surgery,the maximum nighttime resting,and coughing VAS significantly increased on the first and second days after surgery (P < 0.05). Compared with the DK group,the resting and coughing VAS on the second day after surgery significantly decreased in the DBK group (P < 0.05). There was no significant difference in the PCIA pressing frequencies between the two groups (P > 0.05). Compared with the sleep indexes before surgery,the nighttime awakening frequencies significantly increased (P < 0.05),the nocturnal sleep duration significantly decreased (P < 0.05),time to fall asleep significantly increased (P < 0.05),and the PSQI and subjective sleep quality significantly increased on the first and second days after surgery (P < 0.05). Compared with the DK group,the time to fall asleep,and subjective sleep quality significantly decreased in the DBK group (P < 0.05). Conclusion The application of DEX combined with BUT and KET for PCIA can provide effective analgesia and improve postoperative sleep quality.
Key words: dexmedetomidine, butorphanol tartrate, ketorolac tromethamine, patient-controlled infusion analgesia, sleep quality
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