右美托咪定复合舒芬太尼术后静脉自控镇痛的临床疗效

Clinical efficacy of postoperative intravenous patient-controlled analgesia with dexmedetomidine combined with sufentanil

目的观察右美托咪定复合舒芬太尼术后静脉自控镇痛(PCA)的效果。方法妇科手术患者100例均分为两组,术后分别应用右美托咪定复合舒芬太尼(P组)和舒芬太尼单药(S组)行常规静脉PCA。镇痛药物配方:P组舒芬太尼5~6μg/kg+右美托咪定200μg;S组舒芬太尼7~8μg/kg。均加入阿扎司琼30mg,并用0.9%氯化钠稀释到150ml。背景输注量1.5ml/h,PCA单次剂量1.0ml,锁定时间8min。术后均持续镇痛72h,术后1h、24h、48h和72h评估痛觉数字评分(NRS)和镇静评分(LOS)。记录不良反应。结果两组镇痛期间的安静和活动状态下的NRS及LOS评分均较满意,组间亦无统计学差异(P>0.05)。P组舒芬太尼用量为(5.7±0.6)μg/kg,少于S组的(7.5±0.7)μg/kg(P<0.01)。P组恶心发生率为4.0%(2/50),呕吐发生率为2.0%(1/50),少于S组的16.0%(8/50)和14.0%(7/50)(P<0.05)。结论与舒芬太尼单药比较,右美托咪定复合舒芬太尼行术后静脉PCA能减少舒芬太尼用量和不良反应。

Objective To observe the clinical efficacy of postoperative intravenous patientcontrolled analgesia（PCA）with dexmedetomidine combined with sufentanil.Methods One hundred patients underwent gynecological surgery were equally assigned into two groups.Conventional postoperative intravenous PCA was performed with combined use of dexmedetomidine 200 μg and sufentanil 5-6 μg/kg（group P）or with sufentanil 7-8 μg/kg alone（group S）.Azasetron 30 mg was added into the analgesic solution of both groups,which was diluted with normal saline upto 150 ml.The analgesic variables were set up as a background infusion of 1.5 ml/h and PCA bolus dose of 1 ml in a lockout interval of 8 minutes.The analgesia lasted for 72 hours.The numerical rating score（NRS）for pain and level of sedation（LOS）were evaluated at 1 hour,24 hours,48 hours and 72 hours during analgesia.The adverse effects were recorded as well.Results The scores of NRS and LOS at rest and active status were all satisfactory in two groups and not significantly different between two groups（P〉0.05）.The consumption of sufentanil in group P was（5.7±0.6）μg/kg,which was significantly lower than（7.5±0.7）μg/kg in group S（P〈0.01）.The incidence rates of nausea and vomiting in group P were 4.0%（2/50）and 2.0%（1/50）,respectively,which were significantly lower than 16.0%（8/50）and 14.0%（7/50）in group S（P〈0.05）.Conclusion Compared to sufentanil alone,postoperative intravenous PCA with dexmedetomidine combined with sufentanil provides a satisfactory analgesia with less adverse effects.