Efekti sufentanila u kombinaciji sa deksmedetomidinom za intravensku analgeziju koju kontroliše bolesnik posle transplantacije bubrega
Sažetak
Uvod/Cilj. Intravenska injekcija jednog ili više pomoćnih lekova, koju kontroliše bolesnik, najpouzdanija je analgetska metoda u današnje vreme. Cilj rada bio je da se proceni efekat sufentanila u kombinaciji sa deksmedetomidinom za intravensku analgeziju koju kontroliše bolesnik (patient-controlled intravenous analgesia – PCIA), nakon transplantacije bubrega. Metode. Izvršena je selekcija 78 bolesnika kojima je u opštoj anesteziji izvršena transplantacija bubrega živog davaoca. Urađeno je skeniranje radioizotopima, a pojedinačna stopa glomerulske filtracije jednog bubrega bila je ≥ 40 mL/min/1.73 m2. Ispitanici iz kontrolne grupe (KG) i posmatrane grupe (PG) (po 39 bolesnika u obe grupe) primili su u cilju analgezije sufentanil i sufentanil sa deksemedetomidinom, redom. Kada je skor Vizuelne analogne skale (VAS) bio iznad 4 poena, intravenski je injektirano 0,05 mg/kg oksikodona za dodatnu analgeziju. Nivoi endotelina, uree i kreatinina u plazmi mereni su radioimunoesejem. Frekvencija srčanog rada (heart rate – HR), srednji arterijski pritisak, saturacija kiseonikom, skor VAS i skor sedacije beleženi su pre anestezije i posle operacije. Zabeleženi su stopa dodavanja analgetika, broj efektivnog pritiska PCIA pumpe i stopa incidencije neželjenih reakcija tokom 48 sati posle operacije. Rezultati. Nađena je značajno niža HR kod PG u odnosu na KG 6 i 12 sati posle operacije (p < 0,05). Skor VAS u PG bio je niži nego u KG 6, 12 i 24 sata posle operacije (p < 0,05). Kod PG utvrđena je niža stopa postoperativnog dodavanja leka, broja efektivnih pritisaka na PCIA pumpu i stope incidencije mučnine i povraćanja, u odnosu na KG (p < 0,05). Nivoi endotelina, uree i kreatinina su se značajno snizili posle operacije, u poređenju sa nivoima pre anestezije (p < 0,05). Nivoi u PG bili su niži od nivoa u KG na svakoj posmatranoj tački posle operacije (p < 0,05). Zaključak. Sufentanil u kombinaciji sa deksmedeto-midinom se može bezbedno i efikasno koristiti za PCIA posle transplantacije bubrega, sa uspešnijim ishodom u odnosu na primenu samog sufentanila.
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