右美托咪定复合舒芬太尼在不同手术术后镇痛中的应用

Application of Dexmedetomidine Combined with Sulfentanyl in Postoperative Analgesia of Different Operation

目的：探讨右美托咪定复合舒芬太尼在不同手术术后镇痛应用效果和临床意义。方法90例ASA分级Ⅰ～Ⅱ级、年龄30～65岁以下的择期手术患者使用右美托咪定复合舒芬太尼进行术后镇痛，其中包括30例胃癌根治术（ A组），30例宫颈癌根治术（ B组），30例全髋关节置换术（ C组）；三组均用右美托咪定2μg/kg＋舒芬太尼0.15μg/kg＋托烷司琼6 mg加入生理盐水稀释至100 mL，静脉镇痛泵首剂均为4 mL，背景输注速度2 mL/h，自控给药剂量0.5 mL，锁定时间15 min。记录术后6、12、24和48 h视觉模拟疼痛（ VAS）评分和Ramsay镇静评分，以及患者夜间睡眠状态和不良反应发生的情况。结果 A组和B组各时间点VAS评分均＜4分，C组各时间点明显高于A组和B组，差异有统计学意义（ P＜0.05），其中术后6 h VAS评分＞4分，其他时间点VAS评分＜4分；C组夜间睡眠质量及镇静满意度明显低于A组和B组，差异有统计学意义（P＜0.05），但三组患者术后各时点Ramsay镇静评分均为镇静满意；三组患者术后恶心呕吐、寒颤、心动过缓的发生率低。结论右美托咪定复合舒芬太尼术后镇痛具有良好的镇静、镇痛效果，不良反应少，是一种值得推荐的术后镇痛方式，其腹部镇痛效果优于肢体关节镇痛。

Objective To observe application of dexmedetomidine combined with sulfentanyl in postoperative analge -sia of different operation.Methods 90 cases patients （ASA I-II, Age 30-65） include gastric cancer radical correc-tion （group A）, uterine cervix cancer radical correction （group B） and replacement of total hip （group C） with 30 cases each.Three groups were all administrated of 2 μg/kg of dexmedetomidine , 0.15 μg/kg of sulfentanyl and 6 mg of tropi-setron in the postoperative analgesia pumps which were adjusted in a standard of 100 mL volume, first dose of 4 mL, bo-lus dose of 2 mL,add dose of 0.5 mL and the lock time was 15 min.The visual analogue score （VAS）,Ramsay calm score （6,12,24,and 48 h after operation） and adverse reaction were recorded.Results The VAS were lower than four at each time points both in group A and group B.The VAS of group C at each time points were higher than group A and B（P〈0.05）,the VAS were higher than four at 6h points, and lower than four at the other two time points.Ramsay calm score were well and the adverse reaction were low among every time points of all three groups .The sleep and conscious -sedation quality of group C were lower than group A and B （ P〈0.05 ）.Conclusions Dexmedetomidine combined with sulfentanyl in postoperative analgesia were deserve recommended which could offer well analgesia and conscious -seda-tion with few adverse effect , especially in the belly operation.