右美托咪定对舒芬太尼术后自控镇痛的影响

Effects of dexmedetomidine on patient controlled intravenous analgesia with sufentanil

目的探讨右美托咪定对舒芬太尼术后自控镇痛的影响。方法择期全身麻醉下经腹子宫全切术患者60例,美国麻醉学家学会分级Ⅰ～Ⅱ级,随机分为右美托咪定组和对照组,每组30例。右美托咪定组在手术结束前1 h缓慢泵入(10 min)右美托咪定0.6μg.kg-1,对照组在手术结束前1 h缓慢泵入(10 min)相同体积生理盐水,然后静脉连接舒芬太尼自控镇痛泵,镇痛泵含舒芬太尼2μg.kg-1+托烷司琼5 mg溶于生理盐水100 mL,负荷剂量4 mL,背景输注2 mL.h-1,自控剂量0.5 mL.h-1,锁定时间15 min。记录自控静脉镇痛开始后1、2、6、12、24 h的视觉模拟评分法(VAS)评分、拉姆齐镇静规模(RSS)评分、舒芬太尼累计消耗量;记录术后24 h内患者恶心、呕吐和寒战等发生情况。结果自控静脉镇痛开始后1、2、6、12、24 h VAS和RSS评分2组间比较差异均无统计学意义(P>0.05)。右美托咪定组舒芬太尼累计消耗量明显少于对照组,术后24 h内恶心、呕吐和寒战的发生率明显低于对照组,差异均有统计学意义(P<0.05)。结论手术结束前1 h缓慢泵入右美托咪定可降低术后舒芬太尼用量,并降低术后恶心、呕吐和寒战等不良反应的发生率。

Objective To investigate the effects of dexmedetomidine on patient controlled intravenous analgesia（PCIA） with sufentanil. Methods Sixty patients,American society of anesthesiologists Ⅰ- Ⅱ ,who underwent abdominal hysterecto- my and general anaesthesia, were randomly divided into dexmedetomidine group and control group, thirty cases in each group. The patients in dexmedetomidine group were given dexmedetomidine 0.6 μg·kg-1（ in 10 minutes）while the patients in con- trol group were given the same volume normal saline one hour before the operation finished. Then a standardized sufentanil PCIA pump was connected to the patients. The analgesia pump included sufentanil 2 μg·kg-1 in 100 mL saline with tropise- tron 5 mg, the loading dose was 4 mL, backgroud dose was 2 mL·h-1, the patient controlled analgesia dose was 0.5 mL·h -1 , the lock time was fifteen minutes. The scores of visual analogue scales （VAS） and Ramsay sedation scale （RSS） and consumption of sufentanil were recorded 1,2,6,12 and 24 hours after PCIA, and the incidence rates of the nausea, vomi- ting and shivering were recorded too in 24 hours. Results There was no statistical significance between the two groups in the scores of VAS and RSS 1,2,6,12 and 24 hours after PCIA （ P 〉 0.05 ）. The consumption of sufentanil and the incidence of postoperative nausea,vomiting and shivering in the dexmedetomidine group were less than those in the control group （ P 〈 0.05 ）. Conclusion It can reduce the consumption of sufentanil and the incidence of postoperative nausea, vomiting and shiv- ering that the patients are given dexmedetomidine one hour before the operation finished.