右美托咪定联合芬太尼对下肢骨折术后静脉自控镇痛的影响

Effects of combining dexmedetomidine and fentanyl for patient-controlled intravenous analgesia in fracture of lower limb

目的 观察右旋美托咪啶（dexmedetomidine,Dex）联合芬太尼用于下肢骨折切开复位内固定术后静脉自控镇痛（PCIA）的效果.方法 选择90例ASA Ⅰ~Ⅱ级于腰硬联合麻醉下行下肢骨折切开复位内固定手术的患者,术后行PCIA,随机分为3组（n=30）.3组术中均给予Dex 1 μg/kg静脉输注,输注时间30min.组1：芬太尼1.0 mg＋阿扎司琼7 mg PCIA;组2：Dex 5 μg/kg＋芬太尼0.5 mg＋阿扎司琼7 mg PCIA;组3：Dex 10 μg/kg＋芬太尼0.5 mg＋阿扎司琼7 mg PCIA.分别记录术后4、8、18、24、48 h的疼痛视觉模拟评分（VAS）,镇静程度评分（OAA/S）,PICA泵的按压次数;记录PCIA的不良反应.结果 组1、组3镇痛效果均满意,PICA泵的按压次数较组2低（P〈0.05）;组2、组3术后恶心呕吐、皮肤瘙痒发生率明显低于组1（P〈0.05）;3组均未发生心动过缓、过度镇静和呼吸抑制.结论 Dex联合芬太尼用于下肢骨折术后PCIA,不仅可减少阿片类药物的剂量,还可减少PICA的不良反应.

Objective To observe the effects of combining dexmedetomidine （Dex） and fentanyl for postoperative patient - controlled intravenous analgesia （PCIA） for fracture of lower limb. Methods Ninety ASA I - II patients un- derwent fracture of lower limb postoperative PCIA were randomly divided into 3 groups （ n = 30 each）. Three groups were given Dex 1 μg/kg intravenous infusion for 30 min. For postoperative PCIA treatment, group 1 received fentanyl 1.0 mg plus azasetron 7 mg, group 2 received fentanyl 0.5 mg plus Dex 5 p^g/kg and azasetron 7 rag, group 3 received fentanyl 0.5 mg plus Dex 10 p.g/kg and azasetron 7 rag. Visual Analog Scale （VAS） , Observers Assessment of Alertness/Seda- tion （OAA/S） and PICA pump time were recorded at 4 （ T1 ）, 8 （ T2 ）, 18 （ T3 ）, 24 （ T4 ）, and 48 h （ T5 ） during post- operative period. The complications of PCIA were also recorded. Results The analgesia effects were satisfied in group 1 and 3, PICA pump time was shorter than group 2 （ P 〈 0.05 ）. The rates of postoperative nausea and vomitiug （PONV） and itchy skin in group 2 and group 3 were lower than in group 1 （ P 〈 0.05 ）. No bradycardia, excessive sedation and r~,spiralury depression were observed in all the 3 groups. Conclusion The addition of Dex to PCIA results in superior analgesia, significant fentanyl sparing and reduction of the complications of PCIA .