右美托咪啶复合舒芬太尼用于开胸术后患者自控静脉镇痛的效果

Effect of dexmedetomidine combined with sufentanil for patient-controlled intranenous analgesia after thoracotomy

目的观察右关托咪啶复合舒芬太尼用于开胸术后患者自控静脉镇痛（PCIA）的临床效果。方法将60例行开胸肺叶切除或肺大疱切除术后PCIA的患者随机双盲分为三组，每组20例。A组使用舒芬太尼0．04μg/（kg·h），B组和c组分别使用舒芬太尼0．04μg/（kg·h）加右美托咪啶0．07μg/（kg·h）和0．10μg/（kg·h），均以生理盐水稀释至100ml。监测并记录PCIA后2、4、6、12、24h平均血压（MBP）、心率（HR）、动脉血氧饱和度（SpO2）、视觉模拟评分法（VAS评分）和Ramsay镇静评分、24h内总按压次数、舒芬太尼用量及不良反应情况。结果B、C组在不同时点MBP与A组比较差异均无统计学意义（P〉0．05），而HR在PCIA后4、6、12、24h低于A组（P〈0．05），Sp02在4、6h高于A组（P〈0．05）；PCIA后4、6、12、24hVAS评分C组〈B组〈A组，Ramsay评分c组〉B组〉A组（P〈0．05）；24h内PCIA总按压次数、舒芬太尼用量及恶心、呕吐、皮肤瘙痒的发生率C组〈B组〈A组（P〈0．05）。结论右关托咪啶可增强开胸术后舒芬太尼PCIA的效果，减少舒芬太尼用量，降低不良反应发生率。

Objective To evaluate the effect of dexmedetomidine combined with sufentanil for patient-controlled intravenous analgesia （PCIA） after thoracotomy. Methods Sixty ASA I or II patients undering thoracotomy were randomly divided into 3 groups（20 cases in each group）. Group A： sufentanil 0. 04 μg/（ kg · h ）. Group B ： sufentanil 0.04 μg/（ kg · h ） ＋ dexmedetomidine 0. 07 μg/（ kg·h ）. Group C ： sufentanil 0. 04 μg/（kg· h） ＋ dexmedetomidine 0. 10 μg/（kg·h）. PCIA setting as follows： background infusion 2 ml/h and bolus dose 0.5 ml and lockout interva l0 rains. Mean artery pressure （MAP） , HR, SpO2, VAS score and Ramsay sedation score were recorded at 2, 4, 6, 12 and 24 hours after the beginning of PCIA. The number of successfully delivered doses and cumulative sufentanil consumption and side effects such as nausea and vomiting within 24 hours were also recorded. Results There were no differences among three groups in MAP at each time. HR and VAS score in group A were significantly higher than those in group B and C at 4, 6, 12 and 24 hours （P 〈 0. 05）. Group C 〉 group B 〉group A in ramsay scores at 4, 6, 12 and 24 hours （P 〈 0. 05）. The number of successfully delivered doses and cumulative sufentanil consumption and side effects such as nausea and vomiting within 24 hours were group C 〈 group B 〈 group A （P 〈 0. 05 ）. Conclusions Dexmedetomidine added to intravenous sufentanil PC A can improve the analgesic efficacy after thoracotomy with less adverse.