不同剂量右美托咪定复合舒芬太尼用于口腔癌患者围手术期镇痛的疗效及对睡眠质量的影响

doi:10.3969/j.issn.1006-5725.2025.14.019

Abstract

Abstract:

Objective To investigate the effect of high， middle and low dose dexmedetomidine combined with sufentanil on perioperative analgesia and sleep quality in patients with oral cancer. Methods A total of 158 patients undergoing oral cancer surgery in the hospital from January 2023 to June 2024 were selected and divided into group A［n = 53，0.6 μg/（kg·h） dexmedetomidine + 2 μg/kg sufentanil］and group B［n = 53，0.4 μg/（kg·h） dexmedetomidine + 2 μg/kg sufentanil］， Group C ［n = 52， 0.2 μg/（kg·h） dexmedetomidine + 2 μg/kg sufentanil］by random number table method. Stress response indexes ［brain-derived neurotrophic factor （BDNF）， cortisol （Cor）， interleukin-6 （IL-6）］， bifrequency index and analgcsia nociccption index（BIS， ANI）， pain level， T lymphocyte subsets CD3⁺， CD4⁺， CD8⁺ levels， Richards Campbell Sleep Scale （RCSQ） score and adverse reactions were compared between the two groups. Results Compared with 12 h before surgery， serum levels of BDNF， Cor and IL-6 in 3 groups were decreased 48 h after surgery， group A was lower than group B， group C， group B was lower than group C（P < 0.05）. Compared with T₀， BIS at T₁ ~ T₃ were significantly different between the 3 groups （P < 0.05）， BIS at T₁ ~ T₃ were lower than those at T₀ （P < 0.05）， and there was no significant difference in BIS at the same time between the 3 groups （P>0.05）， from T₁ to T₃， ANI was higher than that at T₀， and ANI in group A was higher than that in group B and group C （P < 0.05）. Compared with the preoperative results， the pain scores of the 3 groups were decreased at 1 h， 6 h， 24 h and 48 h after operation， and the pain scores of group A were lower than those of group B and C， and the pain scores of group B were lower than those of group C （P < 0.05）. After operation， CD3⁺ and CD4⁺ were decreased in all 3 groups， group A was lower than group B and group C， group B was lower than group C （P < 0.05）， and CD8⁺ was increased in all 3 groups， group A was higher than group B and group C， group B was higher than group C （P < 0.05）. Compared with 1 day before the operation， the sleep quality scores of the three groups on the night after the operation and the second night after the operation were all decreased， group A was lower than group B and group C， and group B was lower than group C（P < 0.05）. The incidence of hypotension and sinus bradycardia in group A was higher than that in group B and group C （P < 0.05）. There was no significant difference in the incidence of hypotension and sinus bradycardia between group B and group C （P > 0.05）. There was no significant difference in the incidence of nausea， vomiting and dizziness among the three groups （P > 0.05）. Conclusion The analgesic effect of 0.6 μg/（kg·h） dose dexmedetomidine combined with sufentanil can effectively reduce the body's stress response and immune suppression， improve sleep quality， but with a greater incidence of intraoperative hypotension and bradycardia.

Key words: oral cancer, dexmedetomidine, sufentanil, different doses, analgesia, sleep quality

CLC Number:

R739.86

Xiaomei BAO,Yu LIU,Chengcheng JIN,Luping. WANG. Effects of different dose dexmedetomidine combined with sufentanil on perioperative analgesia and sleep quality in patients with oral cancer[J]. The Journal of Practical Medicine, 2025, 41(14): 2250-2257.

Figures/Tables 7

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References 28

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项目	A组（n = 53）	B组（n = 53）	C组（n = 52）	χ²/F值	P值
性别/［例（%）］				0.152	0.696
男	28（52.83）	30（56.60）	30（57.69）
女	25（47.17）	23（43.40）	22（42.31）
ASA分级/［例（%）］				0.152	0.696
Ⅱ级	30（56.60）	28（52.83）	28（53.85）
Ⅲ级	23（43.40）	25（47.17）	24（46.15）
年龄/岁	48.65 ± 6.27	48.58 ± 6.24	48.11 ± 6.78	0.109	0.897
体质量指数/（kg/m²）	22.34 ± 2.21	22.31 ± 2.17	22.01 ± 2.45	0.336	0.715
手术时间/min	121.52 ± 10.33	122.40 ± 10.21	122.89 ± 10.53	0.236	0.790
术中出血量/mL	70.34 ± 5.66	68.52 ± 5.89	69.40 ± 5.44	1.360	0.258
麻醉时间/min	111.52 ± 4.70	110.40 ± 4.35	110.78 ± 4.36	0.859	0.426

项目	A组（n = 53）	B组（n = 53）	C组（n = 52）	F值	P值
BDNF/（μg/L）
术前12 h	5.36 ± 1.11	5.42 ± 1.16	5.40 ± 1.18	0.037	0.963
术后48 h	3.46 ± 0.78^?	4.33 ± 0.77^?&	4.58 ± 0.70^?&#	32.280	< 0.001
Cor/（μg/L）
术前12 h	514.39 ± 25.07	516.32 ± 25.06	516.77 ± 25.43	0.133	0.876
术后48 h	119.15 ± 20.32^?	201.88 ± 20.31^?&	208.70 ± 22.52^?&#	295.611	< 0.001
IL-6/（ng/L）
术前12 h	19.81 ± 5.76	19.74 ± 5.75	19.54 ± 5.22	0.033	0.968
术后48 h	9.25 ± 1.29^?	12.86 ± 2.22^?&	14.12 ± 2.52^?&#	78.244	< 0.001

组别	BIS				ANI
组别	T₀	T₁	T₂	T₃	T₀	T₁	T₂	T₃
A组（n = 53）	95.55 ± 3.17	47.36 ± 9.52^?	58.51 ± 9.17^?&	89.30 ± 4.33^?&#	48.27 ± 3.17	50.07 ± 2.07^?	62.12 ± 3.97^?&	75.57 ± 4.77^?&#
B组（n = 53）	95.43 ± 3.36	45.94 ± 7.35^?	55.80 ± 8.23^?&	90.55 ± 6.58^?&#	48.27 ± 3.12	50.97 ± 2.00^?	60.07 ± 3.81^?&	71.52 ± 3.77^?&#
C组（n = 52）	95.12 ± 3.44	42.77 ± 5.61^?	52.65 ± 6.33^?&	93.15 ± 5.77^?&#	48.38 ± 3.14	50.92 ± 2.85^?	57.92 ± 3.76^?&	68.45 ± 3.64^?&#
F_时间	125.422				158.422
P_时间	< 0.001				< 0.001
F_组间	0.588				189.533
P_组间	0.721				< 0.001
F_交互	22.122				129.521
P_交互	< 0.001				< 0.001

组别	术前	术后1 h	术后6 h	术后24 h	术后48 h
A组（n = 53）	2.58 ± 0.45	2.27 ± 0.57	1.77 ± 0.32^*	1.51 ± 0.17^*&	1.30 ± 0.14^*&#
B组（n = 53）	2.55 ± 0.42	2.23 ± 0.56	1.94 ± 0.35^*	1.80 ± 0.23^*&	1.55 ± 0.12^*&#
C组（n = 52）	2.60 ± 0.45	2.26 ± 0.52	2.04 ± 0.30^*	1.90 ± 0.20^*&	1.67 ± 0.18^*&#
F_时间	31.376
P_时间	< 0.001
F_组间	62.470
P_组间	< 0.001
F_交互	13.879
P_交互	< 0.001

组别	例数	CD3⁺		CD4⁺		CD8⁺
组别	例数	术前	术后3 d	术前	术后3 d	术前	术后3 d
A组	53	43.36 ± 6.11	29.67 ± 4.44^?	38.39 ± 5.07	25.15 ± 3.32^?	20.81 ± 1.76	32.25 ± 5.29^?
B组	53	43.50 ± 6.71	33.47 ± 5.18^?&	38.12 ± 5.06	27.88 ± 3.52^?&	20.74 ± 1.75	28.56 ± 4.22^?&
C组	52	43.58 ± 6.05	37.33 ± 5.25^?&#	38.32 ± 5.18	34.60 ± 3.44^?&#	20.60 ± 1.33	25.44 ± 3.16^?&#
F值		0.016	31.196	0.040	105.459	0.226	32.733
P值		0.984	< 0.001	0.961	< 0.001	0.798	< 0.001

Effects of different dose dexmedetomidine combined with sufentanil on perioperative analgesia and sleep quality in patients with oral cancer

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组别	术前1 d	术后当晚	术后第2晚
A组（n=53）	35.44 ± 4.42	22.75 ± 3.02^?	15.13 ± 2.01^?&
B组（n=53）	35.53 ± 4.39	25.38 ± 3.25^?	18.88 ± 3.07^?&
C组（n=52）	35.28 ± 4.58	29.89 ± 3.18^?	23.28 ± 3.89^?
F_时间	35.452
P_时间	< 0.001
F_组间	72.588
P_组间	< 0.001
F_交互	18.522
P_交互	< 0.001

组别	恶心呕吐	头晕	低血压	窦性心动过缓
A组（n = 53）	2（3.77）	2（3.77）	28（52.83）	26（49.06）
B组（n = 53）	3（5.66）	3（5.66）	20（37.74）^?	20（37.74）^*
C组（n = 52）	4（7.69）	4（7.69）	15（28.85）^?	13（25.00）^?
Z值	0.751	0.751	6.450	6.497
P值	0.687	0.687	0.040	0.039

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