右美托咪定联合舒芬太尼在内科胸腔镜检查中的应用价值：一项随机对照试验

The Application Value of Dexmedetomidine Combined with Sufentanil in Internal Medicine Thoracoscopy: A Randomized Controlled Trial

摘要: 目的：目前的研究缺乏对右美托咪定与舒芬太尼联用的镇静、镇痛作用效果的评估。在本研究中，通过比较单纯使用舒芬太尼与右美托咪定联用舒芬太尼，探索联合使用麻醉药物在内科胸腔镜中的镇静、镇痛作用效果。方法：参与的受试者(n = 87)均接受舒芬太尼镇痛，随机选择其中一组在使用舒芬太尼的基础上接受右美托咪定(n = 45) (A组)治疗，另一组(n = 42) (B组)仅使用舒芬太尼。主要观察的结局指标是呼吸科医生评定的手术总体满意度评分；关键的次要结局指标是呼吸科医生评定的咳嗽评分、患者评定的面部疼痛量表评分、手术持续时间、血流动力学变量的变化、舒芬太尼的总额外剂量和手术期间出现的不适症状。结果：A组患者的手术总体满意度评分显著高于B组(分别为8.61 ± 1.7和6.95 ± 1.13) (P = 0.032)；咳嗽评分A组显著低于B组(A组：3.2 ± 1.57和B组：5.3 ± 1.31 (P = 0.037))；同样的，患者面部疼痛量表评分也是A组低于B组(A组：3.12 ± 0.93和B组：4.3 ± 0.71 (P = 0.019))；另外，我们发现B组舒芬太尼额外给药剂量显著大于A组(P < 0.001)。两组在局部麻醉、皮肤切开、胸腔镜插入和活检时的反应相似。两组的血流动力学参数也具有可比性。此外，本研究提示右美托咪定联合舒芬太尼组的患者更愿意接受重复内科胸腔镜检查。结论：这项实验结果表明，联合应用右美托咪定和舒芬太尼对行内科胸腔镜检查的患者镇静效果更强。这些观察结果需要在更多的随机对照试验中得到证实。

Abstract: Objective: The current research lacks a comparison of the sedative and analgesic effects of the combination of dexmedetomidine and sufentanil. In this study, the sedative and analgesic effects of dexmedetomidine combined with sufentanil were explored in internal medicine thoracoscopy compared to the use of sufentanil alone. Methods: All participants (n = 87) received sufentanil for pain relief and were randomly treated with dexmedetomidine (n = 45) (Group A) on the basis of sufentanil, while the other group (n = 42) (Group B) only received sufentanil. The main outcome measure observed is the overall satisfaction score of the surgery assessed by the respiratory doctor; The key secondary outcome measures are cough score assessed by respiratory physicians, pain scale score assessed by patients, duration of surgery, change in hemodynamic variables, total external dose of sufentanil, and discomfort symptoms during surgery. Result: The satisfaction scores of patients in Group A were significantly higher than those in Group B (8.61 ± 1.7 and 6.95 ± 1.13, respectively) (P = 0.032); Cough scores were 3.2 ± 1.57 in Group A and 5.3 ± 1.31 in Group B (P = 0.037); The patient-rated faces pain scale were 3.12 ± 0.93 in Group A and 4.3 ± 0.71 in Group B (P = 0.019); Patients in Group B require more additional doses of sufentanil than those in Group A (P < 0.001). The reactions of the two groups during local anesthesia, skin incision, thoracoscopic insertion, and biopsy were similar. The hemodynamic parameters of the two groups are also comparable. In addition, if necessary, patients in the combination of dexmedetomidine and sufentanil group are more willing to repeat internal thoracoscopy examinations. Conclusions: The results of this experiment indicate that the combination of dexmedetomidine and sufentanil is more effective in sedation for patients undergoing internal thoracoscopy. These observations need to be confirmed in more randomized controlled trials.