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目的观察氢吗啡酮联合不同剂量右美托咪定用于腹腔镜下老年前列腺癌患者术后镇痛的效果。方法将纳入研究的拟行腹腔镜下前列腺癌根治术的老年患者75例采用随机数字方法随机分为3组,H组、HD_1组及HD_2组,每组各25例。3组患者分别在术毕前30 min,经静脉缓慢注射氢吗啡酮20μg/kg后接静脉镇痛泵,H组配方为氢吗啡酮0.1 mg/kg用生理盐水稀释至100 ml;HD_1组配方为氢吗啡酮0.1 mg/kg联合右美托咪定2μg/kg用生理盐水稀释至100 ml;HD_2组配方为氢吗啡酮0.1 mg/kg联合右美托咪定4μg/kg用生理盐水稀释至100ml。监测并记录3组患者术后苏醒时间,拔管时间、复苏室停留时间、术后1 h(T_1)、6 h(T_2)、12 h(T_3)、24 h(T_4)、36 h(T_5)、48 h(T_6)VAS评分、Ramsay评分、肛门排气时间及不良反应诸如恶心呕吐、皮肤瘙痒、呼吸抑制、心动过缓、低血压及口干的发生情况。结果 3组患者在术后苏醒时间、拔管时间、复苏室停留时间及术后各时间点Ramsay评分方面差异无统计学意义(P>0.05)。HD_1、HD_2组VAS评分除T1时点外,其他各时间点VAS评分明显低于H组(P<0.05),肛门排气时间明显快于H组(P<0.05),术后不良反应方面,HD_2组患者在术后口干及低血压发生率方面明显高于H组和DH_1组患者,其他差异无统计学意义。结论 0.1 mg/kg氢吗啡酮复合2μg/kg右美托咪定用于老年患者前列腺癌术后镇痛效果好,不良反应少,值得临床推广应用。
Objective To observe the effect of hydromorphone in combination with different doses of dexmedetomidine for postoperative analgesia of elderly patients with prostate cancer under laparoscopy. Methods A total of 75 elderly patients undergoing laparoscopic radical prostatectomy were randomly divided into 3 groups: H group, HD_1 group and HD_2 group, 25 cases in each group. The patients in group 3 received intravenous injection of hydromorphone 20 μg / kg 30 min before the end of operation. The rats in group H were given hydromorphone 0.1 mg / kg diluted with saline to 100 ml. Group HD_1 To hydromorphone 0.1 mg / kg combined with dexmedetomidine 2μg / kg diluted with saline to 100 ml; HD 2 formula hydromorphone 0.1 mg / kg dexmedetomidine 4μg / kg with saline diluted to 100ml. The recovery time, extubation time, resuscitation room stay time, postoperative T 1, T 2, T 2, T 4, T 36, ), 48 h (T_6) VAS score, Ramsay score, anal exhaust time and adverse reactions such as nausea and vomiting, pruritus, respiratory depression, bradycardia, hypotension and dry mouth. Results There was no significant difference in Ramsay score between the three groups in postoperative recovery time, extubation time, resuscitation room stay time and postoperative time points (P> 0.05). VAS scores of HD_1 and HD_2 group were significantly lower than those of H group at other time points (P <0.05), except for T1 time points, and anal exhaust time was significantly faster than that of H group (P <0.05). In postoperative adverse reactions, HD2 patients in postoperative incidence of dry mouth and hypotension was significantly higher than the H group and DH_1 patients, the other differences were not statistically significant. Conclusion 0.1mg / kg hydromorphone combined with 2μg / kg dexmedetomidine for elderly patients with postoperative analgesic effect of prostate cancer, adverse reactions, worthy of clinical application.