右美托咪定多模式镇痛对老年患者全髋置换术后自控静脉镇痛效果的影响

Effects of multi-mode administration of dexmedetomidine on postoperative patient-controlled intravenous analgesia in elderly patients with total hip replacement

目的探讨右美托咪定多模式镇痛对老年患者全髋置换术后自控静脉镇痛(PCIA)效果的影响。方法择期行全髋置换术患者120例,采用随机数字表法分为4组(n=30):正常对照(N)组、右美托咪定超前镇痛(D)组、右美托咪定负荷量联合术后镇痛(DS)组和右美托咪定连续输注联合术后镇痛(DiS)组。患者入麻醉复苏室(T_0)及术后6 h(T_1)、12 h(T_2)、24 h(T_3)、48 h(T_4)分别进行VAS和Ramsay评分,记录镇痛泵按压次数和有效按压次数及呼吸抑制、恶心、呕吐、瘙痒等不良反应。结果与N组比较,DS组T_1~T_4时刻、DiS组T_0~T_4时刻VAS明显降低,DS组T_1、T_2及DiS组T_1~T_3时刻Ramsay评分明显升高,DS组、DiS组术后48 h PCIA有效按压次数/总按压次数及补救镇痛比例降低,差异有统计学意义(P<0.05);与D组比较,DS组T_1、T_3时刻、DiS组T_1~T_3时刻VAS明显降低,DS组T_1、T_2及DiS组T_1~T_3时刻Ramsay评分明显升高,DS组、DiS组术后48 h PCIA有效按压次数/总按压次数及DiS组补救镇痛比例降低,差异有统计学意义(P<0.05)。与DS组比较,DiS组T_1时刻Ramsay评分明显升高,差异有统计学意义(P<0.05)。结论右美托咪定对全髋置换术老年患者有适度镇静和加强舒芬太尼镇痛作用的优势,可安全有效地应用于临床。

AIM To investigate the dexmedetomidine given on multimodal analgesia after total hip replace- ment in elderly patients＇ controlled intravenous analgesia. METHODS A total of 120 patients undergoing elec- tived total hip replacement surgery were randomly assigned into 4 groups （n = 30 ） ： normal control group （group N）, dexmedetomidine given preemptive analgesia group （ group D） , dexmedetomidine loading dose joint postopera- tive analgesia group （group DS） and dexmedetomidine continuous infusion joint analgesia group （group DIS）. The VAS and Ramsay score of patients were recorded after they were sent into the anesthesia care unit （To） , postopera- tive 6 h （T1）, 12 h （T2）, 24 h （T3） and 48 h （T4）. The analgesia pump press freguency, effective press fre- quency, respiratory depression, nausea, vomiting, itching and other adverse reactions were also recorded. RE- SULTS Compared with group N, VAS at To - T4 in group DS and at To - T4 in group DiS decreased, Ramsay score at T1 ,T2 in group DS and at T1 - T3 in group DiS increased. The pressing times / total number of compres- sions in group DS, group DiS 48 h after operation reduced and the percentage of remedial analgesia also reduced（ P 〈 0.05 ）. Compared with group D, VAS at T1 , T3 in group DS and at T1 - T3 in group DiS decreased, and Ram- say score at T1 ,T3 in group DS and at TI - T3 in group DiS increased. The effective pressing times / total number in group DS, group DiS 48 h after operation reduced and the percentage of remedial analgesia of the group DiS also re- duced （ P 〈 0.05 ）. Compared with the group DS, Ramsay score at T1 in group DiS increased （P 〈 O. 05 ）. CON- CLUSION Dexmedetomidine for total hip arthroplasty in elderly patients has moderate sedation and can strengthen the advantages of sufentanil analgesic effects, and can be safely and effectively used in clinical practice.