右美托咪定复合麻醉对老年患者单侧膝关节置换术后静脉自控镇痛效果的观察

目的观察右美托咪定复合麻醉对老年患者单侧膝关节置换术后静脉自控镇痛效果。方法选择单侧膝关节置换术患者共45例,随机将患者分为基础用药组、右美托咪定低剂量组和右美托咪定高剂量组,其中每组15例患者。各组患者于手术结束后,给患者配带镇痛泵,在基础用药组中给予舒芬太尼,按照1μg/(kg·d),格拉司琼共6 mg配成150 m L溶液;右美托咪定低剂量组在给予基础用药的同时加入右美托咪定0.5μg/(kg·d);右美托咪定高剂量组是在给予基础用药的同时加入右美托咪定1μg/(kg·d)。记录患者在术后30 min、1、3、6、12、24、48 h的VAS评分,记录Rammsay镇静评分,并在48 h后计算PCA按压次数与舒芬太尼总消耗量。结果手术后,3组患者所有时间点的VAS评分均<4分,右美托咪定低剂量组在膝关节置换术术后1 h和3 h疼痛程度较基础用药组轻(P<0.05),而其它时间则与基础用药组相比差异无统计学意义;右美托咪定高剂量组24 h内疼痛都较基础用药组和右美托咪定低剂量组轻(P<0.05),术后48 h与其它组差异无统计学意义。右美托咪定组患者按压次数明显小于基础用药组(P<0.05)。记录患者术后的Ramsay镇静评分,各组间差异无统计学意义。右美托咪定低剂量和高剂量组2组满意率均显著高于基础用药组(P<0.05)。结论右美托咪定联合舒芬太尼用于老年单侧膝关节置换术术后镇痛,具有良好的镇痛效果,在减轻患者疼痛的同时,减小舒芬太尼消耗量,减轻恶心、呕吐和嗜睡等不良反应。

Objective To observe the Sufentanil combined with Dexmedetomidine on Patient-Controlled Analgesia in eldly patients undergoing unilateral knee arthroplasty. Methods Total of 45 patients including 29 male patients and 16 female patients with unilateral knee arthroplasty were selected. Patients were divided into three groups including control group, Dexmedetomidine low-dose group and Dexmedetomidine high-dose group, 15 patients in each group randomly. Patients in each groups used PCIA pumps after surgery. Sufentanil 1μg/（kg·d） and granisetron 6 mg were maked up with saline for 150mL in control group; Sufentanil 1μg/（kg·d）, dexmedetomidine 0.5μg/（kg·d） and granisetron 6 mg were maked up with saline for 150mL in Dexmedetomidine low-dose group; Sufentanil 1μg/（kg·d）, dexmedetomidine 1μg/（kg·d） and granisetron 6 mg were maked up with saline for 150ml in Dexmedetomidine high-dose group. Observe the VAS scores after surgery in 30 min, 1, 3, 6, 12, 24 and 48 h, Ramsay sedation scale, presses rates in 48h, total consumption of sunfentanil after surgery in 48 h. Results After the operation, all the patients’ VAS scores were less than 4; patients in Dexmedetomidine low-dose group felt less pain in 1h and 3h compared with patients in control group, while the difference was disappeared in other time points; Dexmedetomidine high-dose group felt less pain in 24h than other groups, but the difference was disappeared after 48 h. Patients in Dexmedetomidine groups press less than patients in control group （P〈0.05）. There was no statistically significant difference among Ramsay sedation scores in those groups. Patients in Dexmedetomidine groups were significantly higher satisfaction compared with control group. Conclusion The fomula of sufentanil combined with dexmedetomidine on patient-controlled Analgesia in eldly patients undergoing unilateral knee arthroplasty has advantages in alleviating pain, reducing sufentanil consumption and the incidence of adverse reaction of sufentanil. Meanwhile, this fomula may relieve nausea, vomiting and lethargy and other adverse reactions.