右美托咪定混合羟考酮用于胃肠道手术后病人自控静脉镇痛的适宜药量配比

Optimum ratio of medicine dosage for dexmedetomidine mixed with oxycodone used for PCIA aftergastrointestinal surgery

目的 探讨右美托咪定混合羟考酮用于胃肠道手术后病人自控静脉镇痛的适宜药量配比.方法 择期开腹胃肠外科手术病人80例,年龄35 ～ 64岁,ASA分级Ⅰ或Ⅱ级,体重55～ 75kg,性别不限,采用随机数字表法分为4组（n=20）：羟考酮组（O组）和羟考酮与右美托咪定不同药量配比组（OD1-3组）.手术结束前15 min,静脉注射羟考酮0.1 mg/kg,同时连接自控静脉镇痛泵,药物配制：O组羟考酮1.00 mg/kg;OD1组羟考酮1.00 mg/kg＋右美托咪定2.5μ g/kg;OD2组羟考酮0.75mg/kg＋右美托咪定2.5 μg/kg;OD3组羟考酮0.50 mg/kg＋右美托咪定2.5 μg/kg,各组均用生理盐水稀释至100 ml,背景输注速率2 ml/h,PCA剂量0.5 ml,锁定时间15 min.采用静脉注射羟考酮0.05mg/kg进行补救镇痛,维持VAS评分≤4分.记录术后48 h内补救镇痛情况,PCA有效按压次数、心动过缓、低血压、恶心、呕吐、镇静过度、嗜睡、皮肤瘙痒、呼吸抑制等不良反应的发生情况;记录术后72 h时病人镇痛满意度.结果 4组均未行补救镇痛,均未见镇静过度、呕吐、呼吸抑制和低血压发生.与O组比较,OD1组嗜睡发生率升高,OD2组和OD3组恶心、嗜睡、心动过缓和皮肤瘙痒发生率降低,3组病人术后镇痛满意度升高（P＜0.05）;与OD1组比较,OD2组和OD3组恶心、嗜睡、心动过缓和皮肤瘙痒发生率降低,OD3组病人术后镇痛满意度升高（P＜0.05）,D2组病人术后镇痛满意度差异无统计学意义（P＞0.05）;与OD2组比较,OD3组不良反应发生率比较差异无统计学意义（P＞0.05）,OD3组病人术后镇痛满意度降低（P＜0.05）;与O组、OD1组和OD2组比较,OD3组PCA有效按压次数增加（P＜0.05）.结论 右美托咪定2.5 μg/kg混合羟考酮0.75 mg/kg为胃肠道手术后病人自控静脉镇痛的适宜药量配比.

Objective To investigate the optimum ratio of medicine dosage for dexmedetomidine mixed with oxycodone used for patient-controlled intravenous analgesia （PCIA） after gastrointestinal surgery.Methods Eighty patients of both sexes, aged 35-64 yr, weighing 55-75 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective gastrointestinal surgery, were randomly divided into 4 groups （n=20 each） using a random number table： oxycodone group （group O）, and different ratios of medicine dosage when dexmedetomidine was added to sufentanil groups （OD1-3 groups）.At 15 min before the end of surgery, oxycodone 0.1 mg/kg was injected intravenously, and PCIA pump was connected simultaneously.In group O, the PCIA solution contained oxycodone 1.00 mg/kg in 100 ml of normal saline.In group OD1, the PCIA solution contained oxycodone 1.00 mg/kg and dexmedetomidine 2.5 μg/kg in 100 ml of normal saline.In group OD2 , the PCIA solution contained oxycodone 0.75 mg/kg and dexmedetomidine 2.5 μg/kg in 100 ml of normal saline.In group OD3, the PCIA solution contained oxycodone 0.50 mg/kg and dexmedetomidine 2.5 μg/kg in 100 ml of normal saline.The PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Oxycodone 0.05 mg/kg was injected intravenously as a rescue analgesic, and visual analogue scale score was maintained ≤ 4.The requirement for rescue analgesics was recorded.The requirement for the rescue analgesic was recorded within 48 h after surgery.The number of successfully delivered doses, and occurrence of adverse reactions such as bradyeardia, hypotension, nausea, vomiting, over-sedation, somnolence, pruritus, and respiratory depression were recorded.Patient＇s satisfaction with analgesia was recorded at 72 h after surgery.Results No patients required the rescue analgesic or developed over-sedation, vomiting, respiratory depression and hypotension in the four groups.Compared with group O, the incidence of somnolence was significantly increased in group OD1, the incidence of nausea, somnolence, bradycardia and pruritus was decreased in OD2 and OD3 groups, and the degree of patient＇s satisfaction with analgesia was increased in OD1-3 groups （P〈0.05）.Compared with group OD1, the incidence of nausea, somnolence, bradycardia and pruritus was significantly decreased in OD2 and OD3 groups, the degree of patient＇s satisfaction with analgesia was increased in group OD3 （P〈0.05） , and no significant was found in the degree of patient＇s satisfaction with analgesia in group OD2 （P〉0.05）.Compared with group OD2, no significant was found in the incidence of adverse reactions （P〉0.05） , and the degree of patient＇s satisfaction with analgesia was significantly decreased in group OD3 （P〈0.05）.The number of successfully delivered doses was significantly larger in group OD3 than in O, OD1 and OD2 groups （P〈0.05）.Conclusion Dexmedetomidine 2.5 μg/kg added to oxycodone 0.75 mg/kg is the optimum ratio of medicine dosage when used for PCIA after gastrointestinal surgery.