右美托咪定复合芬太尼在全麻病人术后静脉自控镇痛的应用

Application of dexmedetomidine combined with fentanyl in postoperative patient-controlled intravenous analgesia for patients under general anethesia

目的评价右美托咪定复合不同剂量芬太尼在全麻病人术后静脉自控镇痛的效果及安全性。方法选取择期在全麻下行腹腔镜全子宫切除术的患者60例,随机分为三组,两个实验组(S1和S2)分别给予右美托咪定+不同剂量芬太尼静脉自控镇痛泵,对照组(C)给予芬太尼静脉自控镇痛泵;观察和记录患者术后48h内的心率(HR)、平均动脉压(MAP)的变化情况,术后疼痛评分(VAS评分)和并发症情况。结果术后VAS评分比较,实验组明显优于对照组,差异有统计学意义(P<0.01);术后实验组的血流动力学较对照组更为平稳;对照组术后恶心、呕吐的发生率明显高于实验组(P<0.05)。结论右美托咪定复合芬太尼在全麻术后静脉自控镇痛中具有良好的效果,可以减少芬太尼的用量,对血液动力学的影响和不良反应较单用芬太尼小。

Objective To assess the effect and safety of dexmedetomidine combined with different doses of fentanyl in postoperative patient-controlled intravenous analgesia（PCIA） for patients under general anethesia.Methods 60 pa- tients who underwent laparoscopic panhysterectomy under general anesthesia,were randomly divided into two experi- mental groups （group S1 and group S2） and one control group （group C） with 20 cases in each group.Group S1 and group S2 were treated by dexmedetomidine combined with different doses of fentanyl for PCIA,while group C were treated with fentanyl for PCIA.Then,changes of heart rate （HR） and mean arterial pressure （MAP） within 48 h as well as VAS scores and complications of all groups were observed and recorded.Results VAS scores of group S1 and group S2 were significantly better than that of the group C after the operation, so the differences were statistically sig- nificant（ P 〈0.01）.Compared with group C, Group S1 and group S2 had more stable hemodynamics.The incidence rate of adverse effects such as nausea,vomitting in group C was significantly higher than those of group S1 and group S2（ P 〈0.05）.Conclusion Dexmedetomidine combined with different doses of fentanyl has positive effect in postop- erative patient-controlled intravenous analgesia（PCIA） for patients under general anethesia.Dosages of fentanyl can be reduced accordingly.Such combination has less influence on hemodynamic changes and adverse effects than single use of fentanyl.