右美托咪啶复合舒芬太尼用于胸椎结核术后患者自控静脉镇痛效果的临床观察

Effects of dexmedetomidine combined with sufentanil in treatment of patient-controlled intravenous analgesia after thoracic tuberculosis surgery

目的观察右美托咪啶复合舒芬太尼用于胸椎结核术后患者自控静脉镇痛(PCIA)的临床效果。方法将2011年6月至2013年9月收治的60例胸椎结核术后PCIA患者随机双盲分为三组,每组20例。A组(对照组)使用舒芬太尼0.06μg/(kg·h),以生理盐水稀释至100 m L;B组使用舒芬太尼0.06μg/(kg·h)、右美托咪啶0.05μg/(kg·h),C组使用舒芬太尼0.06μg/(kg·h)、右美托咪啶0.10μg/(kg·h),B、C组均加入托烷司琼5 mg,以生理盐水稀释至100 m L。监测并记录三组患者PCIA后2、4、6、12、24 h平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(Sp O2)、视觉模拟评分(VAS)和Ramsay镇静评分、24 h内总按压次数、舒芬太尼用量及不良反应等情况。结果 B、C组患者不同时间点MAP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、24 h低于A组,差异均有统计学意义(P<0.05),Sp O2在PCIA后4、6、12、24 h高于A组,差异均有统计学意义(P<0.05);PCIA后4、6、12、24 h VAS由高至低依次为A、B、C组,Ramsay镇静评分由高至低依次为C、B、A组,差异均有统计学意义(P<0.05);24 h内PCIA总按压次数,舒芬太尼用量,恶心、呕吐、皮肤瘙痒发生率由高至低依次为A、B、C组,差异均有统计学意义(P<0.05)。结论右美托咪啶可增强胸椎结核术后舒芬太尼PCIA效果,减少舒芬太尼用量,降低不良反应发生率。

Objective To observe the clinic effect of dexmedetomidine combined with sufentanil for patient-controlled intravenous analgesia（PCIA） after thoracic tuberculosis surgery. Methods Sixty PCIA patients after thoracic tuberculosis surgery from June 2011 to September 2013 were randomly divided into 3 groups,20 cases in each group. Group A（the control group） was given 0.06 μg/（kg·h）sufentanil deliquated to 100 m L with normal saline.Group B with 0.06 μg/（kg·h） sufentanil combined with0.05 μg/（kg·h）dexmedetomidine. Group C with 0.06 μg/（kg·h） sufentanil combined with 0.10 μg/（kg·h） dexmedetomidine,all of which were added with 5 mg tropisetron deliquated to 100 m L with normal saline,too. The mean arterial pressure（MAP）,hear rate（HR）,saturation of pulse oximetry（Sp O2）,VAS score,Ramsay sedation score,cumulative compression frequency within 24 hours,sufentanil consumption doses and side effects were also recorded at 2nd,4th,6th,12 th and 24 th hours after the beginning of PCIA. Results There were no statistial significance in differences of MAP at various time in the group B,C compared with group A（P〉0.05）. The HR in group B,C were significantly lower than those in group A at 2nd,4th,6th,12 th and 24 th hours after PCIA while Sp O2 in group B,C was higher than that of the control group at 4th,6th hours after PCIA,both of which had a statistical significance in difference（P〈0.05）. It ranked from high to low of group A,B and C in VAS at 4th,6th,12 th and 24 th hours after PCIA,in turn,the Ramsay sedation score ranked. The difference was statistically significant（P〈0.05）. cumulative compression frequency within 24 hours,sufentanil consumption dosage and side effects such as nausea,vomiting and pruritus ordered group C,group B,group A,whose differece had a statistical significance（P〈0.05）. Conclusion Dexmedetomidine may strenghten intravenous sufentanil PCIA analgesic efficacy after thoracic tuberculosis surgery,decrease sufentanil consumption doses and reduce the incidence of adverse effect.