右美托咪定复合酮咯酸氨丁三醇在腹腔镜结直肠癌术后静脉自控镇痛中的应用及安全性分析

李树武　李晓锋　寇广海

[摘要] 目的 探討右美托咪定复合酮咯酸氨丁三醇（Ket）在结直肠癌（CRC）腹腔镜术后静脉自控镇痛中的应用及安全性。 方法 选取辽宁省盘锦辽油宝石花医院于2016年1月至2018年1月收治的CRC患者107例进行前瞻性研究，以RNTM将其分成A、B、C组，各37例、35例和35例，其中A组单纯予以右美托咪定治疗，B组单纯予以酮咯酸氨丁三醇治疗，C组则联合（Dex联合Ket）治疗，且所有A、B、C组的手术方法均相同，即为腹腔镜CRC术，比较三组患者的自控镇痛效果及其安全性。 结果 （1）C组术后T1、T2、T3、T4、T5时的VAS（静息痛、活动痛）评分均低于A、B组，差异有统计学意义（P<0.05），而A、B组术后T1～T5时的以上两项疼痛评分指标均无显著差异（P>0.05）。（2）三组术后48 h内的镇痛、药物及排气时间差异有统计学意义（P<0.05），且C组术后48 h内的有效按压次数、镇痛急救次数、舒芬太尼使用总量、术后肛门首次排气时间与A、B组相比更低（P<0.05）。（3）A组不良反应发生率为32.43%，B组为37.14%，C组为8.57%，三组不良反应发生率比较，差异有统计学意义（P<0.05），且C组不良反应发生率显著低于A、B组，差异有统计学意义（P<0.05）。 结论 在CRC患者的临床治疗中科学、合理地予以Dex复合Ket治疗能有效地改善患者腹腔镜术后PCIA效果，安全性较好，可在临床医学中适当推广与普及，为CRC及相关并发症患者造福。

[关键词] 右美托咪定;酮咯酸氨丁三醇;腹腔镜;结直肠癌;静脉自控镇痛;安全性

[中图分类号] R614          [文献标识码] B          [文章编号] 1673-9701（2021）04-0106-05

Application and safety analysis of dexmedetomidine combined with ketorolac tromethamine in patient-controlled intravenous analgesia after laparoscopic colorectal cancer surgery

LI Shuwu   LI Xiaofeng   KOU Guanghai

Anesthesiology Department， Panjin Liaoyou Baoshihua Hospital in Liaoning Province， Panjin   124000， China

[Abstract] Objective To explore the application and safety of dexmedetomidine combined with ketorolac tromethamine in patient-controlled intravenous analgesia after laparoscopic surgery for colorectal cancer（CRC）. Methods A total of 107 CRC patients in Panjin Liaoyou Baoshihua Hospital from January 2016 to January 2018 were selected for prospective study. They were divided into group A（n=37）， group B（n=35） and group C（n=37） by RNTM. Group A was treated with dexmedetomidine， group B was treated with ketorolac tromethamine， and group C was treated with dexmedetomidine combined with ketorolac tromethamine. All groups underwent the same operation-laparoscopic CRC. The efficacy and safety of patient-controlled analgesia were compared among the three groups. Results （1）VAS（rest pain and movement pain） score and RSS score of group C at T1， T2， T3， T4 and T5 after operation were lower than those of group A and B， with statistically significant difference（P<0.05）. There was no significant difference between group A and group B in the above two pain scoring indexes from T1 to T5 after operation（P>0.05）. （2）There were significant differences in analgesia， medication and exhaust time among the three groups within 48 hours after operation（P<0.05）， and the effective pressing times， analgesia times， total amount of sufentanil used and first exhaust time of anus after operation in group C were lower than those in group A and group B（P<0.05）. （3） The adverse reaction rates of group A， group B and group C were 32.43%， 37.14% and 8.57%， respectively. There was significant difference among the three groups（P<0.05）， and the adverse reaction rates of group C were significantly lower than those of groups A and B（P<0.05）. Conclusion Dexmedetomidine combined with ketorolac tromethamine can effectively improve the PCIA effect of CRC patients after laparoscopic surgery， with high safety. Thus， this combined therapy can be properly promoted and popularized in clinic for the benefit of CRC patients and related complications.

[Key words] Dexmedetomidine; Ketorolac tromethamine; Laparoscopy; Colorectal cancer; Patient-controlled intravenous analgesia; Safety

我国是目前结直肠癌（Colorectal cancer，CRC）的低发区，但近年来的流行病学研究数据表明，目前我国CRC的发生率在不少地区有程度不等的增加趋势[1]。CRC作为一种常见、多发的胃肠道恶性肿瘤，由于其早期症状并不显著，故极难被诊断出来，而随着癌肿增大或病情加剧[2]，其临床症状也随之变得明显，必须采取相应的治疗措施。右美托咪定（Dexmedetomidine，Dex）作为一种常见的选择性α2-肾上腺素受体激动剂，它不仅具有镇静作用，有文献表明[3]，其在镇痛方面也有较好的临床效果。酮咯酸氨丁三醇（Ketochromate，Ket）常用于痛症缓解，在创伤和术后疼痛、肿痛、剧烈痛及各种原因引起的疼痛中均有较好的效果[4]，且安全性更高。借此，本文选取本院收治的107例CRC患者进行前瞻性研究，探讨右美托咪定复合Ket在该病治疗中的镇痛作用和安全性。……