右美托咪定复合低剂量舒芬太尼在胸腔镜手术后镇痛效果观察：随机对照临床研究

Effect of dexmedetomidine combined with sufentanil on postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery

目的观察右美托咪定复合舒芬太尼用于胸腔镜手术后镇痛与镇静的效果。方法择期全麻下行胸腔镜手术患者60例，随机分为3组，Ⅰ组（n=20）术后镇痛给予舒芬太尼2．5gg／kg，Ⅱ组（n=20）舒芬太尼2gg／kg，Ⅲ组（n=20）舒芬太尼2gg／kg加右美托咪啶4gg／kg，各组均加阿扎司琼20mg。稀释至100ml泵注。分别记录3组术毕及术后不同时点的VAS及OAA／S镇静评分，并记录首次需要镇痛药的时间及剂量，同时观察不良反应。结果3组患者血液动力学比较差异无统计学意义（P〉0.05），与Ⅱ组比较Ⅰ、Ⅲ组VAS评分较低，且差异有统计学意义（P〈0．05），Ⅱ组首次需要追加镇痛药的时间较短，且所需氟比洛芬酯的总量最多，与Ⅰ组和Ⅲ组差异有统计学意义（P〈0．05）；与Ⅱ、Ⅲ组比较，Ⅰ组恶心呕吐的发生率较高（P〈0．05）。结论右美托咪定复合低剂量舒芬太尼用于胸腔镜手术后镇痛效果满意，且无明显不良反应。

Objective To evaluate the effect of dexmedetomidine combined with sufentanil on postop- erative analgesia in patients undergoing video-assisted thoracoscopie surgery. Methods Sixty patients with scheduled video-assisted thoracoscopic surgery were randomly divided into three groups with 20 patients in each group. The patients in group Ⅰ received sufentanil 2.5 μg/kg, group Ⅱ received sufentanil 2 μg/kg, group Ⅲ received sufentanil 2 μg/kg and dexmedetomidine 4 μg/kg, all with azasetron 20 mg and diluted to a total volume of 100 ml. Visual analogue scale （VAS） and observer＇s assessment of alertness/sedation scale （OAA/S） at the immediate time after operation and 4, 12, 24 and 48 h after operation were recorded. The first time and amount of supplemental intravenous analgesic required and the incidence of side effects were also recorded. Results There were no significant differences among the three groups about hemodynamic changes. Compared with group Ⅲ , VAS was lower in group Ⅰ and Ⅲ （P〈 0.05）. The time required to supplement flurbiprofen was shorter in group Ⅲ than that in group Ⅱ and Ⅲ （P〈 0.05）. Compared with group Ⅱ and Ⅲ ,the incidence of nausea and vomiting were higher in group Ⅰ. Conclusion Dexmedetomidine combined with sufentanil can provide effective postoperative analgesia and fewer side-effects in patients after video-assisted thoracoscopic surgery.