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目的:比较不同剂量右美托咪定与利多卡因联合静注对乳腺癌改良根治术患者术后镇静、镇痛的疗效和安全性。方法:择期乳腺癌改良根治术患者60例随机分为3组:利多卡因组(L组,n=20),术前予利多卡因1.5 mg·kg-1静注后,以1.5 mg·kg-1·h-1静脉泵注利多卡因至术终;低剂量右美托咪定联合利多卡因组(D1组,n=20),术前予右美托咪定0.3μg·kg-1,10min内静脉泵注后,以1.5 mg·kg-1·h-1静脉泵注利多卡因至术终;高剂量右美托咪定联合利多卡因组(D2组,n=20),术前给予右美托咪定0.6μg·kg-1,10 min内静脉泵注后,以1.5 mg·kg-1·h-1持续静脉泵注利多卡因至术终。比较3组患者苏醒期改良OAA/S评分达到3级及BIS达到80时,丙泊酚效应室浓度(Ce3,Ce80);术后1 h,6 h及24 h的VAS评分(VAS1~VAS 24);术后24 h内恶心,呕吐情况。结果:3组患者苏醒期改良OAA/S评分达到3级及BIS达到80时各组间丙泊酚效应室浓度比较,差异无统计学意义(P>0.05)。D1、D2两组术后1 h VAS值较L组明显降低(P<0.05),D1、D2两组间比较,差异无统计学意义(P>0.05)。术后6 h及24 h的VAS值,D2组明显低于L、D1组(P<0.05),L组与D1组比较,差异无统计学意义(P>0.05)。各组间药品不良反应差异无统计学意义(P>0.05)。结论:右美托咪定0.6μg·kg-1和利多卡因联合应用可明显减轻术后急性疼痛,优化患者短期预后,安全性好。
OBJECTIVE: To compare the efficacy and safety of different doses of dexmedetomidine and lidocaine combined with intravenous injection for postoperative sedation and analgesia in patients with modified radical mastectomy. Methods: Sixty patients undergoing modified radical mastectomy for elective breast cancer were randomly divided into three groups: lidocaine group (L group, n = 20), pretreatment with 1.5 mg · kg-1 lidocaine intravenously and 1.5 mg · kg- kg-1 · h-1 intravenous infusion of lidocaine until operation; low-dose dexmedetomidine combined lidocaine group (D1 group, n = 20), preoperative dexmedetomidine 0.3μg · kg After iv infusion of intravenous infusion of lidocaine (1.5 mg · kg-1 · h-1) for 10 min, rabbits were intravenously injected with lidocaine at a dose of 1.5 mg · kg-1 · h-1 and high dose dexmedetomidine plus lidocaine (D2, n = 20 ), Preoperative dexmedetomidine 0.6μg · kg-1,10min intravenous injection, 1.5mg · kg-1 · h-1 continuous intravenous infusion of lidocaine to the end of surgery. The changes of propofol concentration (Ce3, Ce80), VAS scores at 1 h, 6 h and 24 h after operation (VAS1 ~ VAS 24 ); Nausea and vomiting within 24 hours after operation. Results: There was no significant difference in propofol concentration between the three groups when the modified OAA / S score reached grade 3 and the BIS reached 80 (P> 0.05). The VAS values of D1 and D2 groups at 1 h after operation were significantly lower than those at L group (P <0.05). There was no significant difference between D1 and D2 groups (P> 0.05). The VAS values at 6 h and 24 h after operation were significantly lower in D2 group than those in L and D1 groups (P <0.05). There was no significant difference between L group and D1 group (P> 0.05). There were no significant differences in adverse drug reactions between the two groups (P> 0.05). Conclusion: The combination of dexmedetomidine 0.6μg · kg-1 and lidocaine can significantly reduce the postoperative acute pain and optimize the short-term prognosis of patients with good safety.