右美托咪定联合舒芬太尼用于老年胸腔镜手术患者术后镇痛疗效观察

Effect of Dexmedetomidine Combined with Sufentanil on Postoperative Analgesia in Elderly Patients Undergoing Pleural Mirror Surgery

目的：观察右美托咪定联合舒芬太尼对老年胸腔镜手术患者术后镇痛的效果.方法：选择ASAⅡ级胸腔镜手术患者90例 ,随机分成三组 ,每组30例 ,拔除双腔管时连接术后镇痛泵 ,C1组 ：舒芬太尼1 .5μg/kg＋托烷司琼5mg ;C2组：舒芬太尼2μg/kg＋托烷司琼5mg ;E组 ：舒芬太尼1 .5μg/kg＋盐酸右美托咪定2μg/kg＋托烷司琼5mg.观察三组患者拔管后4h、8h、12h、24h、48h镇静、镇痛评分 ,比较三组患者拔管后1~6h、6~12h、12~24h、24~48h镇痛泵的按压次数及三组术后不良反应的例数.结果：在拔管后4h、8h、12h、24h、48h ,VAS评分C1组明显大于C2组和E组 ,差异有统计学意义（P〈0 .05） ,C2组和E组之间差异无统计学意义 ;Ramsay镇静评分C1组明显小于C2组和E组 ,差异有统计学意义（P〈0 .05） ,C2组和E组之间差异无统计学意义.拔管后1~6h、6~12h、12~24h、24~48h镇痛泵的按压次数C1组明显多于C2组和E组 ,差异有统计学意义（ P〈0 .05 ） ,C2组和E组之间差异无统计学意义.三组均未发生呼吸抑制和心动过缓 ,C2组恶心呕吐发生率明显大于C1组和E组.结论：舒芬太尼联合右美托咪定应用于胸科老年患者术后镇痛 ,可达到更好的镇静、镇痛效果 ,减少舒芬太尼用量 ,降低术后不良反应.

Objective：To study effect of dexmedetomidine combined with sufentanil on postoperative analgesia in pa-tients undergoing senile pleural mirror operation .Methods：Ninety senile patients undergoing pleural mirror surgery were randomly divided into three groups ：group C1 received sufentanil 1 .5μg/kg and tropisetron 5mg ;group C2：sufen-tanil 2μg/kg and tropisetron 5mg ;group E：Sufentanil 1 .5μg/kg＋ dexmedetomidine 2μg/kg＋ tropisetron 5mg .Visual analog scale （VAS） and Ramsay scores were recorded after extubation for 4 ,8 ,12 ,24 and 48 hours .The number of self-controlled press of the pump at 1~6h ,6~12h ,12~24h ,24~48h after extubation and the incidence of side effects were recorded .Results：VAS scores of group C1 were significantly higher than that of group C2 and E at 4h ,8h ,12h , 24h and 48h after extubation （P〈0 .05） .Ramsay scores group C1 were significantly lower than that of group C2 and E at 4h ,8h ,12h ,24h and 48h after extubation （P〈0 .05） .There was no statistically significant difference between group C2 and group E in VAS scores and Ramsay scores .The number of self-controlled press of the pump in group C1 was markedly more than that of group C2 and E at 1~6h ,6~12h ,12~24h ,24~48h after extubation（P〈0 .05） .the inci-dence of nausea and vomiting in group C1 was higher than that of group C2 and E （P〈0 .05） ,there was no significant difference between group C2 and group E .Conclusion：Dexmedetomidine can reduce postoperative consumption of sufen-tanil in elderly patients undergoing pleural mirror surgery ,and decrease the incidence of postoperative adverse reac-tions .