舒芬太尼联合右美托咪啶用于子宫切除术后静脉自控镇痛的临床观察

Clinical Observation of Dexmedetomidine Combined with Sufentanil on Patient-Controlled Intravenous Analgesia( PCIA)After Hysterectomy

目的观察盐酸右美托咪定联合舒芬太尼在开腹子宫全切术后患者静脉自控镇痛中的镇痛效果。方法 40例择期在腰硬联合麻醉下行腹式子宫全切手术患者随机分为两组:舒芬太尼组(SF组)和舒芬太尼+盐酸右美托咪啶组(SD组)。SF组镇痛方法为舒芬太尼2.5μg/kg生理盐水稀释至100 m L,SD组为盐酸右美托咪啶1.5μg/kg+舒芬太尼2.5μg/kg,生理盐水稀释至100 m L,两组患者手术结束后行静脉自控镇痛48 h。分别记录镇痛2 h、4 h、8 h、24 h患者的镇痛VAS评分和镇静Ramsay评分;记录镇痛后24 h PCA有效按压次数和舒芬太尼总用量并记录不良反应。结果与SF组相比,SD组在镇痛后4 h、8 h VAS评分降低,两组比较有显著性差异(P<0.05),SF组PCA有效按压次数与舒芬太尼总用量明显增多(P<0.05),两组各时段Ramsay评分无明显差异;SF组术后的恶心、呕吐等不良反应的发生率高。结论舒芬太尼联合盐酸右美托咪啶术后镇痛可明显提高静脉自控镇痛效果,减少镇痛期间不良反应,增加患者术后镇痛舒适度。

Objective To observe the analgesic effect of sufentanil combined with dexmedetomidine on patient-controlled intravenous analgesia （PCIA） after hysterectomy. Methods 40 patients under CSEA for selective trans-abdominal total hysterectomy were randomly divided into two groups evenly： sufentanil group （SF group） and sufentanil ＋ dexmedetomidine （SD group）, The analgesic method of SF group was sufentanil 2.5ug/kg diluted by saline to 100 mL; and dexmedetomidine 1.5ug/kg ＋ sufentanil 2.5ug/kg diluted by saline to 100 mL for SD group. Patients in both groups were administrated PCIA for 48 hours. Patients＇ VAS and Ramsay scores separately at 2 h, 4 h, 8 h, 24 h during PCIA were recorded. The effective PCA press time in 24 h and the total dose of sufentanil, and the side effect of analgesia were recorded. Results Compared with the SF group, the VAS score of SD group reduced at 4 h, 8 h during PCA, with significant difference （P〈0.05）, and the effective PCA press time and the total dose of sufentanil of SF group were significantly increased （P〈0.05）. There was no significant difference of the Ramsay score between two groups at each time point. The side effect incidence of nausea and vomiting was higher in SF group. Conclusions Sufentanil combined with dexmedetomidine hydrochloride can significantly increase the PCIA effect, reduce the side effect during PICA, and increase the postoperative analgesia comfort level of patients.