右美托咪啶与氟比洛芬酯联合舒芬太尼对高龄脊柱患者术后镇痛的效果比较

Evaluation of dexmedetomidine or flurbiprofen combined with sufentanil on postoperative analgesia in elderly patients undergoing spinal surgery

目的观察右美托咪啶复合舒芬太尼与氟比洛芬酯复合舒芬太尼对高龄脊柱患者术后镇痛效果和谵妄发生率的影响。方法选择年龄≥60岁,ASAⅠ-Ⅲ级,择期在全身麻醉下行脊柱手术的患者220例,根据术后镇痛药物不同随机分为D组和F组,每组110例。D组给予盐酸右美托咪定(0.1ug/kg·h)+枸橼酸舒芬太尼(1.5ug/kg)+托烷司琼(10mg)进行静脉自控镇痛(PCIA),F组给氟比洛芬酯(200mg)+枸橼酸舒芬太尼(2ug/kg)+托烷司琼(10mg)进行PCIA。观察2组患者T0(术后30min)、T2h(术后2h)、T6h(术后6h)、T12h(术后12h)、T24h(术后24h)、T48h(术后48h)各时点的VAS疼痛评分和Ramsay镇静评分及不良反应(恶心、呕吐、呼吸抑制以及寒战等),VAS评分4分以上给予补救镇痛药,并记录例数;术后3d内每天2次(7:00-9:00,18:00-20:00)用ICU意识模糊评分法(CAM-ICU)评估谵妄的发生情况。结果 D组在T0-T24h各时点的VAS疼痛评分明显低于F组(P<0.05),镇静评分两组无差别(P>0.05);D组的恶心、呕吐不良反应明显低于F组(P<0.05);F组术后发生谵妄13例(11.82%),D组2例(1.82%)。结论右美托咪啶复合舒芬太尼用于术后镇痛,镇痛效果好,不良反应少,谵妄发生率低。

Objective To evaluate clinical effect of dexmedetomidine or flurbiprofen combined with sufentanil on postoperative analgesia in elderly patients undergoing spinal surgery. Methods Totally 220 patients undergoing spinal surgeries aged over sixty years old,were randomly divided into two groups according to different PCIA formula ： group D received sufentanil（ 1. 5ug / kg） pulus dexmedetomidine（ 0. 1ug / kg·h）,group F received sufentanil（ 2ug / kg） pulus flurbiprofen 200 mg. Tropisetron 10 mg was also added identically in all groups. The presence of delirium,the VAS and Ramsay sedation scale was recorded 30 min and 2、6、12、48h after surgery,and the adverse effects were also recorded. Results Compared with group F,The VAS scores were significantly low at T0 ∽ T24h（ P〈0. 05）. There were no significant differences in Ramsay sedation scale at all time points（ P〈0. 05）. There were two patients of suffering delirium in group D,and thirteen patients in group F. Conclusion Dexmedetomidine combined with sufentanil PCIA in elderly patients undergoing spinal surgery has satisfactory analgesic effect,can decrease the incidence of postoperative delirium and nausea and vomiting.