右美托咪啶复合地佐辛用于腰椎术后患者自控静脉镇痛的效果

Efficacy of dexmedetomidine combined with dezocine for patient-controlled intravenous analgesia for post lumbar surgery

目的 评价右美托咪啶复合地佐辛用于腰椎术后患者自控静脉镇痛（PCIA）的效果。方法 选择ASAⅠ~Ⅱ级择期行腰椎内固定术的患者90例,采用随机数字表法随机分为3组（n=30）：A组采用地佐辛40 mg＋托烷司琼8 mg,B组采用地佐辛50 mg＋托烷司琼8 mg,C组采用地佐辛40 mg＋右美托咪啶200μg＋托烷司琼8 mg;均用生理盐水稀释至150 ml,背景输注速率3 ml/h,自控给药剂量3 ml,锁定时间15 min。所有患者均于手术结束前静脉缓慢注射地佐辛5 mg,托烷司琼2 mg,术后行PCIA。于术后4 h、8 h、24 h、48 h记录VAS评分、Ramsay镇静评分、追加镇痛药例数、镇痛泵按压次数;于术后48 h行患者满意度评价;记录术后镇痛期间不良反应发生情况。结果 B、C组术后4 h、8 h、24 h的VAS评分和镇痛泵按压次数均明显低于同时点A组（P〈0.05）;A、C组总不良反应的发生率明显低于B组（13%、7%vs.30%,P〈0.05）,C组又明显低于A组（P〈0.05）;C组对术后镇痛的总体满意度明显高于A、B组（93%vs.77%、73%,P〈0.05）。结论 右美托咪啶复合地佐辛用于腰椎术后静脉镇痛效果确切,可减少地佐辛的用量,同时降低其不良反应的发生率,且患者对术后镇痛的总体满意度高。

Objective To evaluate the efficacy of dexmedetomidine combined with dezocine for patient-controlled intravenous analgesia （PCIA） for post lumbar surgery. Methods Ninety patients with American Society of Anesthesiologists （ASA） Ⅰ - Ⅱ were scheduled for lumbar internal fixation and randomly divided into three groups （n=30 each）. Dezocine 5 mg and tropisetron 2 mg were given before the end of the operation and PCIA were performed in all the patients. Pa- tients in group A received dezocine 40 mg combined with tropisetron 8 mg, patients in group B received dezocine 50 mg combined with tropisetron 8 mg, patients in group C received dezocine 40 mg combined with dexmedetomidine 200 μg and tropisetron 8 mg. The analgesic pump was set in the three groups as follows： background infusion rate 3 ml/h, single bolus dose 3 ml, lockout interval 15 min, with the total volume of 150 ml. VAS scores, Ramsay sedation scores, the num- ber of patients requiring rescue analgesics and the number of the PCA button pressing were recorded at 4 h, 8 h, 24 h, 48 h after operation. The overall satisfaction of analgesia was recorded during the 48 h and postoperative complications were recorded. Results The VAS scores and times of the PCA button pressing in group B and C were lower at 4 h ,8 h ,24 h after surgery than those in group A. The overall incidence of adverse reactions in group A, group B and group C were 13%, 30% and 7%, respectively, there were significant differences in the incidence between groups （P 〈 0.05）. The overall satisfaction of analgesia from patients in group C was higher than that in group A and B （93% vs. 77%, 73%, P 〈 0.05）. Con- clusion Addition of dexmedetomidine to dezocine for PCIA is an effective approach for post lumbar surgery. It can significantly reduce the consumption of dezocine, decrease the incidence of adverse reactions and improve the overall satisfaction of analgesia from patients.