针药复合麻醉应用右美托咪定对甲状腺切除术后呕吐的影响
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摘要
目的观察针药复合麻醉应用右美托咪定对甲状腺切除术后呕吐的影响。方法将70例行甲状腺切除术患者随机分为A组和B组,每组35例。两组均采用电针合谷、内关和扶突配合术前20 min开始静脉滴注枸橼酸舒芬太尼注射液(0.3mg/kg)进行针药复合麻醉。其中A组在前10 min内微泵恒速输注盐酸右美托咪定注射液(0.5mg/kg),术中维持0.4mg/kg/min。B组术前10 min开始输注生理盐水。观察两组不同时间点[术前入室平卧5 min(T0)、手术开始前(T_1)、手术开始后30 min(T_2)、手术开始后60 min(T_3)和手术结束时(T_4)]的观察者警觉/镇静评分(OAA/S)评分。记录两组术中舒芬太尼追加次数与总使用量,使用艾司洛尔、乌拉地尔的例数,术后2 h内及术后2～24 h内发生呕吐的例数。结果两组舒芬太尼追加次数及总使用量比较差异均具有统计学意义(P<0.01)。A组术中艾司洛尔和乌拉地尔使用率分别为31.4%和14.3%,对照组分别为77.1%和65.7%,两组比较差异具有统计学意义(P<0.01)。A组术后2 h内及术后2～24 h呕吐发生率分别为20.0%和17.1%,对照组分别为54.3%和42.9%,两组比较差异具有统计学意义(P<0.01)。两组不同时间点(T_1、T_2、T_3、T_4)OAA/S评分比较差异均具有统计学意义(P<0.01)。结论针药复合麻醉应用右美托咪定能减少甲状腺切除术中追加舒芬太尼的次数及使用剂量,降低患者术后呕吐的发生率。
Objective To observe the influence of dexmedetomidine applied in combined acupuncture-medication anesthesia on vomiting after thyroidectomy. Method Seventy patients who were going to receive thyroidectomy were randomized into group A and B, with 35 cases in each group. Combined acupuncture-medication anesthesia [electroacupuncture at Hegu(LI4), Neiguan(PC6) and Futu(ST_32) plus intravenous infusions of sufentanil citrate injection(0.3 mg/kg) 20 minutes before operation] was adopted in both groups. Group A was additionally intervened by constantvelocity micropump infusion of dexmedetomidine hydrochloride injection(0.5 mg/kg) within 10 minutes before operation and remaining 0.4 mg/kg/min during operation, while group B was intervened by infusion of normal saline 10 minutes before operation. The observer's assessment of awareness/sedation(OAA/S) scores at different time points[lying in bed for 5 minutes before operation(T0), before the beginning of the operation(T_1), 30 minutes after operation(T_2), 60 minutes after operation(T_3) and at the end of operation(T_4)] in the two groups were observed. The additional times and total dose of sufentanil during operation, the number of cases using esmolol and urapidil, and the number of vomiting cases occurred within 2 hours after operation and 2～24 hours after operation in the two groups were recorded.Result The additional times and total dose of sufentanil during operation in group A were significantly different from those in group B(P<0.01). The utilization rate of esmolol and urapidil were respectively 31.4% and 14.3% in group A versus 77.1% and 65.7% in group B, and the between-group differences were statistically significant(P<0.01). The incidence of vomiting within 2 hours after operation and 2～24 hours after operation were respectively 20.0% and 17.1%in group A versus 54.3% and 42.9% in group B, and the between-group differences were statistically significant(P<0.01). The OAA/S scores at different time points(T_1, T_2, T_3 and T_4) in group A were significantly different from those in group B(P<0.01). Conclusion Dexmedetomidine applied in combined acupuncture-medication anesthesia can reduce the additional times and total dose of sufentanil during thyroidectomy, and it can reduce the incidence of postoperative vomiting as well.
Objective To observe the influence of dexmedetomidine applied in combined acupuncture-medication anesthesia on vomiting after thyroidectomy. Method Seventy patients who were going to receive thyroidectomy were randomized into group A and B, with 35 cases in each group. Combined acupuncture-medication anesthesia [electroacupuncture at Hegu(LI4), Neiguan(PC6) and Futu(ST_32) plus intravenous infusions of sufentanil citrate injection(0.3 mg/kg) 20 minutes before operation] was adopted in both groups. Group A was additionally intervened by constantvelocity micropump infusion of dexmedetomidine hydrochloride injection(0.5 mg/kg) within 10 minutes before operation and remaining 0.4 mg/kg/min during operation, while group B was intervened by infusion of normal saline 10 minutes before operation. The observer's assessment of awareness/sedation(OAA/S) scores at different time points[lying in bed for 5 minutes before operation(T0), before the beginning of the operation(T_1), 30 minutes after operation(T_2), 60 minutes after operation(T_3) and at the end of operation(T_4)] in the two groups were observed. The additional times and total dose of sufentanil during operation, the number of cases using esmolol and urapidil, and the number of vomiting cases occurred within 2 hours after operation and 2～24 hours after operation in the two groups were recorded.Result The additional times and total dose of sufentanil during operation in group A were significantly different from those in group B(P<0.01). The utilization rate of esmolol and urapidil were respectively 31.4% and 14.3% in group A versus 77.1% and 65.7% in group B, and the between-group differences were statistically significant(P<0.01). The incidence of vomiting within 2 hours after operation and 2～24 hours after operation were respectively 20.0% and 17.1%in group A versus 54.3% and 42.9% in group B, and the between-group differences were statistically significant(P<0.01). The OAA/S scores at different time points(T_1, T_2, T_3 and T_4) in group A were significantly different from those in group B(P<0.01). Conclusion Dexmedetomidine applied in combined acupuncture-medication anesthesia can reduce the additional times and total dose of sufentanil during thyroidectomy, and it can reduce the incidence of postoperative vomiting as well.
引文
[1]吴小斌,陆秀娟.针刺麻醉应用于甲状腺手术的临床观察[J].上海针灸杂志,2013,32(6):504-505.
[2]王永强,孙燕翔,李一靖,等.不同频率针药复合麻醉与颈浅丛阻滞麻醉用于甲状腺手术的效应比较[J].江苏中医药,2013,45(4):55-57.
[3]童秋瑜,马文,沈卫东.针药复合麻醉在甲状腺手术中的运用[J].辽宁中医杂志,2012,39(2):334-336.
[4]Shaikh SI,Nagarekha D,Hegade G,et al.Postoperative nausea and vomiting:A simple yet complex problem[J].Anesth Essays Res,2016,10(3):388-396.
[5]Zou Z,Jiang Y,Xiao M,et al.The impact of prophylactic dexamethasone on nausea and vomiting after thyroidectomy:a systematic review and meta-analysis[J].PLo S One,2014,9(10):e109582.
[6]王永强,马文,樊文朝,等.不同频率电针对甲状腺手术针药复合麻醉的麻醉效果影响[J].上海中医药杂志,2012,46(10):10-12.
[7]Sonner JM,Hynson JM,Clark O,et al.Nausea and vomiting following thyroid and parathyroid surgery[J].JClin Anesth,1997,9(5):398-402.
[8]Kranke P,Eberhart LH.Possibilities and limitations in the pharmacological management of postoperative nausea and vomiting[J].Eur J Anaesthesiol,2011,28(11):758-765.
[9]胡妮娟,林驰,李静,等.得气与针刺疗效关系的思考[J].中国针灸,2014,34(4):413-416.
[10]王永强,李连红,马瑜宏,等.针药复合麻醉中应用盐酸右美托咪定的临床效能评价[J].上海中医药大学学报,2015,29(3):41-43.
[11]Fan WC,Ma W,Wang YQ,et al.Observation on effect of electroacupuncture of different frequencies on patients after thyroid surgery:a randomized controlled trial[J].World Journal of Acupuncture-Moxibustion,2014,24(4):35-40.
[12]Bailey PL,Streisand JB,East KA,et al.Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil[J].Anesth Analg,1990,70(1):8-15.
[13]裴皓.盐酸右美托咪定的药理作用与临床应用[J].医药导报,2010,29(12):1603-1607.
[14]Mantz J,Josserand J,Hamada S.Dexmedetomidine:new insights[J].Eur J Anaesthesiol,2011,28(1):3-6.
[15]Eisenach JC,Shafer SL,Bucklin BA,et al.Pharmacokinetics and pharmacodynamics of intraspinal dexmedetomidine in sheep[J].Anesthesiology,1994,80(6):1349-1359.
[16]Willigers HM,Prinzen FW,Roekaerts PM,et al.Dexmedetomidine decreases perioperative myocardial lactate release in dogs[J].Anesth Analg,2003,96(3):657-664.
[17]高建瓴,詹英,杨建平,等.右美托咪定辅助全身麻醉患者的镇静及全身麻醉药物的节俭作用[J].上海医学,2010,33(6):525-527.
[18]霍大勇.右美托咪定辅舒芬太尼用于全麻患者的术后效果观察[J].中国卫生标准管理,2015,6(30):169-170.
[19]张焕焕,李阳,滕秀飞,等.右美托咪定复合舒芬太尼用于妇科腹腔镜手术患者术后镇痛的效果观察[J].中国医科大学学报,2016,45(4):333-336.
[20]陈裕强.右美托咪定联合舒芬太尼应用于结肠癌术后的镇痛效果[J].检验医学与临床,2016,13(8):1057-1059.
[21]唐泽萍.右美托咪定联合舒芬太尼对甲状腺手术术后患者自控静脉镇痛的效果探讨[J].中外医疗,2016,35(13):10-12.
[22]路强,丁路,韩正飞,等.针刺内关穴预防全麻术后恶心呕吐疗效观察[J].中医药临床杂志,2014,26(8):836-837.
[2]王永强,孙燕翔,李一靖,等.不同频率针药复合麻醉与颈浅丛阻滞麻醉用于甲状腺手术的效应比较[J].江苏中医药,2013,45(4):55-57.
[3]童秋瑜,马文,沈卫东.针药复合麻醉在甲状腺手术中的运用[J].辽宁中医杂志,2012,39(2):334-336.
[4]Shaikh SI,Nagarekha D,Hegade G,et al.Postoperative nausea and vomiting:A simple yet complex problem[J].Anesth Essays Res,2016,10(3):388-396.
[5]Zou Z,Jiang Y,Xiao M,et al.The impact of prophylactic dexamethasone on nausea and vomiting after thyroidectomy:a systematic review and meta-analysis[J].PLo S One,2014,9(10):e109582.
[6]王永强,马文,樊文朝,等.不同频率电针对甲状腺手术针药复合麻醉的麻醉效果影响[J].上海中医药杂志,2012,46(10):10-12.
[7]Sonner JM,Hynson JM,Clark O,et al.Nausea and vomiting following thyroid and parathyroid surgery[J].JClin Anesth,1997,9(5):398-402.
[8]Kranke P,Eberhart LH.Possibilities and limitations in the pharmacological management of postoperative nausea and vomiting[J].Eur J Anaesthesiol,2011,28(11):758-765.
[9]胡妮娟,林驰,李静,等.得气与针刺疗效关系的思考[J].中国针灸,2014,34(4):413-416.
[10]王永强,李连红,马瑜宏,等.针药复合麻醉中应用盐酸右美托咪定的临床效能评价[J].上海中医药大学学报,2015,29(3):41-43.
[11]Fan WC,Ma W,Wang YQ,et al.Observation on effect of electroacupuncture of different frequencies on patients after thyroid surgery:a randomized controlled trial[J].World Journal of Acupuncture-Moxibustion,2014,24(4):35-40.
[12]Bailey PL,Streisand JB,East KA,et al.Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil[J].Anesth Analg,1990,70(1):8-15.
[13]裴皓.盐酸右美托咪定的药理作用与临床应用[J].医药导报,2010,29(12):1603-1607.
[14]Mantz J,Josserand J,Hamada S.Dexmedetomidine:new insights[J].Eur J Anaesthesiol,2011,28(1):3-6.
[15]Eisenach JC,Shafer SL,Bucklin BA,et al.Pharmacokinetics and pharmacodynamics of intraspinal dexmedetomidine in sheep[J].Anesthesiology,1994,80(6):1349-1359.
[16]Willigers HM,Prinzen FW,Roekaerts PM,et al.Dexmedetomidine decreases perioperative myocardial lactate release in dogs[J].Anesth Analg,2003,96(3):657-664.
[17]高建瓴,詹英,杨建平,等.右美托咪定辅助全身麻醉患者的镇静及全身麻醉药物的节俭作用[J].上海医学,2010,33(6):525-527.
[18]霍大勇.右美托咪定辅舒芬太尼用于全麻患者的术后效果观察[J].中国卫生标准管理,2015,6(30):169-170.
[19]张焕焕,李阳,滕秀飞,等.右美托咪定复合舒芬太尼用于妇科腹腔镜手术患者术后镇痛的效果观察[J].中国医科大学学报,2016,45(4):333-336.
[20]陈裕强.右美托咪定联合舒芬太尼应用于结肠癌术后的镇痛效果[J].检验医学与临床,2016,13(8):1057-1059.
[21]唐泽萍.右美托咪定联合舒芬太尼对甲状腺手术术后患者自控静脉镇痛的效果探讨[J].中外医疗,2016,35(13):10-12.
[22]路强,丁路,韩正飞,等.针刺内关穴预防全麻术后恶心呕吐疗效观察[J].中医药临床杂志,2014,26(8):836-837.
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