[1]梅　雷.右美托咪定、帕瑞昔布钠单独或复合用药改善开胸术患者苏醒期躁动的效果及安全性[J].新乡医学院学报,2018,35(1):076-79.[doi:10.7683/xxyxyxb.2018.01.019]
　MEI Lei.Effect and safety of dexmedetomidine and parecoxib sodium alone or in double combinations in improving restlessness in recovery period in patients undergoing thoracic surgery[J].Journal of Xinxiang Medical University,2018,35(1):076-79.[doi:10.7683/xxyxyxb.2018.01.019]
点击复制

右美托咪定、帕瑞昔布钠单独或复合用药改善开胸术患者苏醒期躁动的效果及安全性
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年1
页码:
076-79
栏目:
临床研究
出版日期:
2018-01-05

文章信息/Info

Title:
Effect and safety of dexmedetomidine and parecoxib sodium alone or in double combinations in improving restlessness in recovery period in patients undergoing thoracic surgery
作者:
梅　雷
（信阳市中心医院麻醉科，河南　信阳　464000）
Author(s):
MEI Lei
（Department of Anesthesia，the Central Hospital of Xinyang，Xinyang 464000，Henan Province，China）
关键词:
右美托咪定; 帕瑞昔布钠; 躁动; 苏醒期; 安全性
Keywords:
dexmedetomidine; parecoxib sodium; restlessness; recovery period; safety
分类号:
R614
DOI:
10.7683/xxyxyxb.2018.01.019
文献标志码:
A
摘要:
目的　探讨右美托咪定、帕瑞昔布钠单独或复合用药改善开胸术患者苏醒期躁动的效果及安全性。方法　选择信阳市中心医院2014年9月至2016年9月行择期开胸手术的患者128例，随机分为对照组、右美托咪定组、帕瑞昔布钠组和复合组，每组32例。右美托咪定组患者于术前30 min静脉注射10 mL生理盐水，术毕前10 min缓慢静脉注射0.5 μg·kg-1右美托咪定；帕瑞昔布钠组患者于术前30 min静脉注射40 mg（10 mL）帕瑞昔布钠；复合组患者于术前30 min静脉注射40 mg（10 mL）帕瑞昔布钠，并于术毕前10 min缓慢静脉注射0.5 μg·kg-1右美托咪定；对照组患者于术前30 min及术毕前10 min静脉注射等量生理盐水。观察所有患者的手术时间、术中出血量、术中输液量及麻醉时间，并对全部患者麻醉诱导前10 min（T0）、气管导管拔除前15 min（T1）、气管导管拔除时（T2）、气管导管拔除后15 min（T3）时血清肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）及白细胞介素-10（IL-10）水平及TNF-α/IL-10进行检测，同时对全部患者苏醒期躁动及镇静程度进行评价，并对4组患者苏醒期的不良反应进行统计。结果　4组患者的手术时间、术后出血量、术中输液量及麻醉时间比较差异均无统计学意义（P>0.05）。4组患者T1、T2、T3时血清TNF-α、CRP、IL-10水平均显著高于T0时（P<0.05）。T2、T3时血清TNF-α、CRP、IL-10水平显著高于T1（P<0.05），而T3时血清TNF-α、CRP、IL-10水平显著低于T2（P<0.05）。对照组患者T1、T2、T3时TNF-α/IL-10水平显著高于T0时（P<0.05），而其余3组患者T1、T2、T3时TNF-α/IL-10值显著低于T0时（P<0.05）；对照组患者T2、T3时TNF-α/IL-10值显著高于T1（P<0.05），T3时TNF-α/IL-10值显著显著高于T2（P<0.05），其余3组患者T1、T2、T3时TNF-α/IL-10值比较差异无统计学意义（P>0.05）。帕瑞昔布钠组、右美托咪定组及复合组患者在T1、T2、T3时的血清TNF-α、CRP水平及TNF-α/IL-10值均显著低于对照组（P<0.05），而IL-10水平显著高于对照组（P<0.05）。复合组患者T1、T2、T3时血清TNF-α、CRP水平及TNF-α/IL-10值显著低于帕瑞昔布钠组和右美托咪定组（P<0.05），IL-10水平显著高于帕瑞昔布钠组和右美托咪定组（P<0.05）。帕瑞昔布钠组、右美托咪定组及复合组患者的躁动发生率显著低于对照组（P<0.05），而Ramsay镇静评分显著高于对照组（P<0.05），复合组患者的躁动发生率显著低于帕瑞昔布钠组、右美托咪定组（P<0.05）。患者均无心动过速、恶心呕吐、呼吸抑制等不良反应。结论　右美托咪定、帕瑞昔布钠复合用药能显著降低开胸术患者苏醒期躁动的发生率，同时能够对炎性反应产生一定的抑制作用，较单独应用右美托咪定或帕瑞昔布钠具有更好的临床效果。
Abstract:
Objective　To explore the effect and safety of dexmedetomidine and parecoxib sodium alone or in double combinations in improving restlessness in recovery period in patients undergoing thoracic surgery.Methods　One hundred and twenty eight patients who underwent thoracic surgery in the Central Hospital of Xinyang from September 2014 to September 2016 were selected and randomly divided into control group，dexmedetomidine group，parecoxib sodium group and combined group，with 32 cases in each group.Patients in the dexmedetomidine group were given 10 mL of saline at 0.5 h before surgery，and were given a slow injection of 0.5 μg·kg-1 of dexmedetomidine by intravenous injection at 10 minutes before the end of the operation.Patients in the parecoxib group were given 40 mg （10 mL） of parecoxib sodium 0.5 h by intravenous injection before surgery.Patients in the combined group were given 40 mg （10 mL） of parecoxib sodium 0.5 h by intravenous injection before surgery，and were given a slow injection of 0.5 μg·kg-1 of dexmedetomidine intravenously at 10 minutes before the end of the operation.Patients in the control group received intravenous injections of equal saline at 0.5 h before surgery and 10 minutes before the end of the operation.The operation time,peroperative bleeding,peroperative infusion volume,and anesthesia time were observed.Plasma tumor necrosis factor-α （TNF-α），C reactive protein （CRP） and interleukin-10 （IL-10） levels and TNF-α/IL-10 of all patients at the time of 10 min before induction of anesthesia （T0），15 min before extubation （T1），tracheal extubation time （T2），15 min after extubation （T3） were detected.At the same time，restlessness in stage of analepsia and sedation of all patients were evaluated.The adverse reactions of the four groups in the recovery stage were statistically analyzed.Results　There was no significant difference in the operation time,peroperative bleeding,peroperative infusion volume and anesthesia time among the four groups(P>0.05).The levels of TNF-α，CRP and IL-10 at T1，T2 and T3 in the four groups were significantly higher than those at T0 （P<0.05）.The levels of TNF-α,CRP,IL-10 at T2 and T3 were higher than those at T1(P<0.05),but the levels of them at T3 were lower than those at T2 in the four groups(P<0.05).The TNF-α/IL-10 at T1，T2 and T3 in the control group was significantly higher than that at T0 （P<0.05），and TNF-α/IL-10 at T1，T2 and T3 in the other three groups was significantly lower than that at T0 （P<0.05）.The level of TNF-α/IL-10 at T2 and T3 was higher than that at T1,at T3 it was higher than that at T2 in the control group(P<0.05)。But there was no significant difference among the time point of T1,T2 and T3 in the other three groups(P>0.05).Compared with the control group，TNF-α，CRP and TNF-α/IL-10 levels at T1，T2 and T3 in the other three groups were significantly lower（P<0.05），and IL-10 levels were significantly higher（P<0.05）.The levels of TNF-α，CRP and TNF-α/IL-10 at T1，T2 and T3 in the combined group were significantly lower than those in dexmedetomidine group and parecoxib sodium group（P<0.05），while the IL-10 levels were significantly higher（P<0.05）.The restlessness rate in the dexmedetomidine group，parecoxib sodium group and combined group were significantly lower than that in the control group （P<0.05），while the ramsay sedation was significantly higher （P<0.05）.The restlessness rate in combined group was significantly lower than that in dexmedetomidine group and parecoxib sodium group （P<0.05）.All the patients had no tachycardia，nausea，vomiting，respiratory depression and other adverse reactions.Conclusion　Dexmedetomidine combined with parecoxib can reduce the restlessness rate significantly，and can produce some inhibition to the inflammatory reaction.The clinical effect of dexmedetomidine combined with parecoxib is better than dexmedetomidine and parecoxib sodium alone.

参考文献/References:

［1］　夏勇军，李军鹏，李萌，等.右美托咪定联合地佐辛对老年高血压患者全麻苏醒期躁动及血流动力学的影响［J］.临床麻醉学杂志，2015，31（7）：647-651.
［2］　童珊珊，李军，彭春玲，等.麻醉恢复室的成年患者全麻苏醒期躁动危险因素分析［J］.重庆医学，2015，44（10）：1340-1342.
［3］　王志红，赵莉，杨毅，等.盐酸羟考酮联合帕瑞昔布钠对瑞芬太尼复合麻醉患者手术后痛觉过敏的影响［J］.医药导报，2016，35（9）：978-981.
［4］　佟凯.不同剂量右美托咪定对腹腔镜下结直肠癌手术苏醒期躁动及早期认知功能影响的研究［J］.中国内镜杂志，2015，21（4）：356-359.
［5］　章艳君，刘金柱，张文静，等.芬太尼复合地塞米松对扁桃体及腺样体射频消融术患儿苏醒期躁动的影响［J］.临床麻醉学杂志，2015，31（10）：962-965.
［6］　薛国剑，郝建华.右美托咪定在心血管手术麻醉中的应用进展［J］.新乡医学院学报，2016，33（1）：73-77.
［7］　FAULK D J，TWITE M D，ZUK J，et al.Hypnotic depth and the incidence of emergence agitation and negative postoperative behavioral changes［J］.Paediatr Anaesth，2010，20（1）：72-81.
［8］　SON J S，JANG E，OH M W，et al.A comparison of postoperative emergence agitation between sevoflurane and thiopental anesthesia induction in pediatric patients［J］.Korean J Anesthesiol，2015，68（4）：373-378.
［9］　朱玉霖，陈军，罗自立，等.不同时机静注帕瑞昔——布钠对妇科腔镜手术全麻苏醒期躁动的影响［J］.四川医学，2016，37（1）：74-76.
［10］　KIM N Y，KIM S Y，YOON H J，et al.Effect of dexmedetomidine on sevoflurane requirements and emergence agitation in children undergoing ambulatory surgery［J］.Yonsei Med J，2014，55（1）：209-215.
［11］　CILFONE N A，PERRY C R，KIRSCHNER D E，et al.Multi-scale modeling predicts a balance of tumor necrosis factor-α and interleukin-10 controls the granuloma environment during mycobacterium tuberculosis infection［J］.PLoS One，2013，8（7）：e68680.

相似文献/References:

[1]杨吉武,唐靖,朱新运,等.右美托咪定对高血压病患者腰硬联合麻醉的镇静效应及血流动力学的影响[J].新乡医学院学报,2012,29(05):359.
[2]贾英萍,李郑琛,邱永升. 右美托咪定滴鼻复合七氟醚吸入麻醉在小儿舌系带成形术中的应用[J].新乡医学院学报,2015,32(08):732.
[3]李克寒１,马　丽２,杨惠敏１,等. 右美托咪定对心脏瓣膜置换术患者的脑保护作用[J].新乡医学院学报,2015,32(08):762.
[4]祖翠华.腹腔镜胆囊切除术前给予帕瑞昔布钠对患者苏醒期躁动、疼痛及血流动力学的影响[J].新乡医学院学报,2015,32(09):884.
[5]吕绪磊,郝建华.剖宫产术中应用右美托咪定对子宫收缩剂不良反应的作用[J].新乡医学院学报,2015,32(11):1022.
[6]王　旭,张加强.右美托咪定联合七氟烷在小儿先天性心脏病微创封堵手术中的应用效果[J].新乡医学院学报,2021,38(5):445.[doi:10.7683/xxyxyxb.2021.05.010]
　WANG Xu,ZHANG Jiaqiang.Application effect of dexmedetomidine combined with sevoflurane for children with congenital heart disease undergoing minimally invasive closure operation[J].Journal of Xinxiang Medical University,2021,38(1):445.[doi:10.7683/xxyxyxb.2021.05.010]
[7]周　军,张原源,丛旭晖,等.右美托咪定对全身麻醉扁桃体切除术患儿苏醒期躁动的影响[J].新乡医学院学报,2019,36(4):353.[doi:10.7683/xxyxyxb.2019.04.013]
　ZHOU Jun,ZHANG Yuan-yuan,CONG Xu-hui,et al.Effect of dexmedetomidine on agitation during general anesthesia recovery period in children underwent tonsillectomy[J].Journal of Xinxiang Medical University,2019,36(1):353.[doi:10.7683/xxyxyxb.2019.04.013]
[8]杨　燕,张运琼,黄　沾,等.右美托咪定联合舒芬太尼术后镇痛对脊柱手术患者应激反应、炎症反应、氧化应激及免疫功能的影响[J].新乡医学院学报,2020,37(3):277.[doi:10.7683/xxyxyxb.2020.03.019]
　YANG Yan,ZHANG Yunqiong,HUANG Zhan,et al.Effect of dexmedetomidine combined with sufentanil on stress response,inflammatory response and immune function of patients undergoing spinal surgery[J].Journal of Xinxiang Medical University,2020,37(1):277.[doi:10.7683/xxyxyxb.2020.03.019]
[9]张红伟,王卫卫,李晓芳,等.右美托咪定对咽喉部手术鼾症儿童术后躁动及血流动力学的影响[J].新乡医学院学报,2021,38(8):730.[doi:10.7683/xxyxyxb.2021.08.006]
　ZHANG Hongwei,WAGN Weiwei,LI Xiaofang,et al.Effect of dexmedetomidine on postoperative agitation and hemodynamics of patients with snoring after throat surgery[J].Journal of Xinxiang Medical University,2021,38(1):730.[doi:10.7683/xxyxyxb.2021.08.006]
[10]陈胜阳,张永强,刘　俊,等.右美托咪定对行非体外循环冠状动脉旁路移植术患者肺损伤及血清白细胞介素-10、肿瘤坏死因子-α和克拉拉细胞蛋白16水平的影响[J].新乡医学院学报,2021,38(9):828.[doi:10.7683/xxyxyxb.2021.09.006]
　CHEN Shengyang,ZHANG Yongqiang,LIU Jun,et al.Effects of dexmedetomidine on the lung injury and serum interleukin-10,tumor necrosis factor-α and Clara cell protein 16 levels in patients undergoing off-pump coronary artery bypass grafting[J].Journal of Xinxiang Medical University,2021,38(1):828.[doi:10.7683/xxyxyxb.2021.09.006]

更新日期/Last Update: 2018-01-05