| Research BackgroundPostoperative pain tends to arouse excessive stress,as well as physical and psychological harms to the patients,directly affecting the prognosis on patients.There are various perioperative adverse events,such as myocardial ischemia,myocardial infarction,pulmonary infection,ileus,urinary retention and thromboembolism,moreover,postoperative cognitive dysfunction(POCD)is related to this.The ideal way of postoperative analgesia is multimodal analgesia,which is combined different mechanisms of analgesic drugs or analgesic technology for analgesia.Postoperative analgesic drugs have developed rapidly,with a wide variety.And the traditional analgesic drug sufentanil has quick and strong analgesic effects,but it has more side effects.Some patients are intolerant,which greatly restricts its use.Dexmedetomidine(DEX)is a highly selective ?2 receptor agonist,which not only reduces stress response and provides organ protection,but also plays a role in anti-anxiety,sedation and reduces postoperative delirium and agitation.In recent years,there have been more studies on perioperative analgesia about dexmedetomidine.Butorphanol is an opioid receptor partial agonist with good analgesic and sedative effects,especially on visceral pains.Compared with pure opioid agonists,it has fewer side effects(such as nausea,vomiting),low addiction and low toxicity.The extensive clinical effects of dexmedetomidine and butorphanol make them have a great advantage in multimodal analgesia on elderly patients,and there are few clinical studies on relevant aspects.The purpose of this study is to observe the analgesic effects of dexmedetomidine combining with butorphanol on elderly patients with gastrointestinal tumors after laparoscopic surgery,and to explore the efficacy,safety and optimal dose.ObjectiveTo investigate the effects of dexmedetomidine combining with butorphanol on intravenous controlled analgesia(PCIA)after laparoscopic surgery on elderly patients with gastrointestinal tumors.MethodsThis program is approved by the Ethics Committee of the Second Affiliated Hospital of Zhengzhou University.Elderly patients with gastrointestinal tumors undergoing laparoscopic surgery in the Second Affiliated Hospital of Zhengzhou University from December 2018 to December 2019 were selected,and 80 patients were eventually included.They are randomly divided into four groups(n=20),and all of them receive PCIA.Group S:sufentanil(1.5 ?g/kg)+dexmedetomidine(2?g/kg)+tropisetron(0.2mg/kg)Group B1:butorphanol(0.1mg/kg)+dexmedetomidine(2 ?g/kg)+ topensetron(0.2mg/kg)Group B2:butorphanol(0.15mg/kg)+dexmedetomidine(2?g.kg)+topensetron(0.2mg/kg)Group B3:butorphanol(0.2mg/kg)+topensetron(0.2mg/kg)+dexmedetomidine(2?g/kg).The mean arterial pressure(MAP)and heart rate(HR)of the four groups at the time of entering the operating room(T1),immediately after waking up(T2)and postoperative 4h(T3),8h(T4),12h(T5),24h(T6)and 48h(T7),moreover,the visual analog score(VAS score)and the sedation degree(Ramsay score)at the time of T3?T7 and the mini-mental state examination(MMSE)at the time of T1,T2,T4 and T6 and postoperative 3 d(T8)are all recorded.Postoperative rehabilitation indexes of the four groups are recorded:the first fart,the first fluid feeding,the first time to get out of bed and hospital stay.The counts of PCA pump compressions and the effective compressions,pain relief cases as well as the occurrence of various postoperative adverse reactions are observed.Results1.Comparison of general data and intraoperati ve indicators among the four groups showed no statistically significant difference(P>0.05).2.Comparison of hemodynamics of the four groups2.1 Comparison of HR changed in four groups at different timingsThe overall analysis of HR in the four groups showed that the interaction between time effect and grouping effect was significant(F=41.978,P<0.001).The comparison among groups:compared with the S group,the HR in group B1 increased at T4-T7.Compared with group B2,HR in group B1 increased at T4?T7,with a statistically significant difference(P<0.05).Within groups:Compared with T1,HR in group S,B2,B3 decreased at T2?T5,HR in group B2 B3 continued to decrease at T6?T7,and HR in group B1 increased at T6-T7,with a statistically significant difference(P<0.05).2.2 The comparison of MAP changed in four groups at different timingsThe overall analysis of MAP in the four groups showed that the interaction between time effects and grouping effects was significant(F=53.396,P<0.001).The comparison among groups:compared with group S,MAP in group B1 increased at T7.Compared with group B2,MAP in group B1 increased at T5 and T7,with a statistically significant difference(P<0.05).Within groups:compared with T1,MAP in the four groups increased at T2,MAP in group B1 continued to increase at T3?T7,and MAP in group B3 decreased at T5?T7,with a statistically significant difference(P<0.05).3.The comparison of visual analogue scale(VAS)and sedation scale(Ramsay)3.1 The comparison of VAS scores in four groupsThe overall analysis of VAS score in the four groups showed that the interaction between time effects and grouping effects was not significant(F=1.047,P=0.405>0.05).The comparison among groups:compared with S group,VAS score of patients increased at T3?T7 in group B1 and rose at T4 in group B2,with statistically significant differences(P<0.05).Compared with group B2,VAS score increased at T5?T7 in group B1 while decreased at T3?T5 in group B3,with statistically significant differences(P<0.05).Within groups:VAS scores of patients in the four groups decreased gradually with time,and decreased slightly faster with time in group B2.3.2 The Comparison of Ramsay scores in four groupsThe overall analysis of Ramsay scores in the four groups showed that the interaction between time effects and grouping effects was significant.(F=9.698,P<0.001).The comparison among groups:compared with group S,Ramsay score decreased at T3-T4 in group B1 while increased at T5-T7 in group B3,with statistically significant differences(P<0.05).Compared with group B2,Ramsay score decreased at T3-T5 in group B1 while increased at T5-T7 in group B3,with statistically significant differences(P<0.05).Within groups:compared with T3,Ramsay score of patients increased at T7 in group B1 and increased at T6-T7 in group B3,with statistically significant differences(P<0.05).4.The comparison of postoperative rehabilitation indexes in the four groupsCompared with group S,the first time to get out of bed increased and the time of first fart and first fluid feeding decreased in group B1 and B3.All three decreased in group B2;Compared with group B2,the time of first fart,first fluid feeding and first getting out of bed increased in group B1 and B3,with statistically significant differences(P<0.05).There was no statistically significant difference in hospital stay among the four groups(P>0.05).5.The comparison of MMSE scores in four groupsThe overall analysis of MMSE scores in the four groups showed that the interaction between time effects and grouping effects was significant(F=5.187,P<0.001).The comparison among groups:compared with group S,MMSE score of patients increased at T4,T6 and T8 in group B1 and B2,and that of patients increased at T4 and T6 in group B3;Compared with group B2,MMSE score of patients decreased at T8 in group B1,and that of patients decreased at T6 and T8 in group B3;with statistically significant differences(P<0.05).Within groups:compared with T1,MMSE scores of all four groups decreased at T2,T4 and T6;compared with T2,MMSE score increased in all four groups at T6 and T8;compared with T4,the MMSE score of patients increased at T8 in group S and B2,with statistically significant differences(P<0.05).6.The comparison of analgesic remedy in four groups.Compared with group S,the counts of PC A pump compressions and effective compressions of patients increased in group B1.Compared with group B2,the counts of PCA pump compressions and effective compressions of patients increased in group B1,with statistically significant differences(P<0.05).There was no statistically significant difference in the comparison of pain relief plans among the four groups(P>0.05).7.There was no statistically significant difference in the incidence of adverse reactions among the four groups(P>0.05),and no patient was stopped using the analgesic pump due to intolerance complications.Conclusion1.Dexmedetomidine combining with butorphanol can be safely and effectively used for postoperative analgesia on elderly patients with gastrointestinal tumors after laparoscopic surgery,and 0.15mg/kg of butorphanol has the best effects.2.Compared with sufentanil group,dexmedetomidine combining with butorphanol was used for postoperative analgesia on elderly patients with gastrointestinal tumors after laparoscopic surgery,which could reduce the time of the first fart and the first fluid feeding,improve postoperative cognitive function and promote their recovery. |
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