羟考酮混合右美托咪定PCIA用于胰肾联合移植术后镇痛的效果

Efficacy of PCIA with oxycodone mixed with dexmedetomidine for analgesia after combined pancreas-kidney transplantation

目的评价羟考酮混合右美托咪定PCIA用于胰肾联合移植术后镇痛的效果。方法拟在全麻下行同种异体胰肾联合移植术患者40例，性别不限，年龄18～64岁，体重40～100 kg，ASA分级Ⅱ或Ⅲ级。采用随机双盲抽签法分为2组（n＝20）：舒芬太尼组（S组）和羟考酮＋右美托咪定组（OD组）。术毕行PCIA，S组药物：舒芬太尼2.0 μg/kg＋托烷司琼5 mg；OD组：羟考酮0.6 mg/kg＋右美托咪定0.48 μg/kg＋托烷司琼5 mg；均用生理盐水配成100 ml。参数设置：背景输注速率2 ml/h，PCA剂量0.5 ml，锁定时间15 min。于术后4、8、12、24、48 h时记录Ramsay评分、VAS评分，记录术后48 h内术后躁动发生情况和程度。记录恶心呕吐、皮肤瘙痒及呼吸抑制等不良反应的发生情况。术后12、24 h时采集静脉血标本，检测血清BUN、Cr、胱抑素C（Cys C）的浓度，同时记录尿量。结果与S组比较，OD组术后各时点VAS评分降低，Ramsay评分升高，镇静满意率升高，躁动、恶心呕吐发生率降低，血清BUN、Cr、Cys C浓度降低，尿量升高（P〈0.05），躁动程度及皮肤瘙痒发生率差异无统计学意义（P〉0.05）。结论羟考酮混合右美托咪定PCIA用于胰肾联合移植术后镇痛的效果确切，安全性较高，且有助于促进移植肾功能恢复。

Objective To evaluate the efficacy of patient-controlled intravenous anesthesia（PCIA）with oxycodone mixed with dexmedetomidine for analgesia after combined pancreas-kidney transplantation.Methods Forty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 18-64 yr, weighing 40-100 kg, scheduled for elective combined allogeneic pancreas-kidney transplantation, were randomly divided into 2 groups（n=20 each）： sufentanil group（group S）and oxycodone combined with dexmedetomidine group（group OD）. PCIA was performed at the end of surgery.PCIA solution contained sufentanil 2.0 μg/kg and tropisetron 5 mg in 100 ml of normal saline in group S, and oxycodone 0.6 mg/kg, dexmedetomidine 0.48 μg/kg and tropisetron 5 mg in 100 ml of normal saline in group OD.The PCIA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h.Ramsay sedation score and visual analog scale score were recorded at 4, 12, 24 and 48 h after surgery.The development and degree of agitation were recorded within 48 h after surgery.The development of adverse reactions such as nausea and vomiting, pruritus and respiratory depression was recorded.Venous blood samples were collected at 12 and 24 h after surgery for determination of serum blood urea nitrogen, creatinine and cystatin C concentrations, and the urine volume was calculated.Results Compared with group S, visual analog scale score was significantly decreased, Ramsay sedation score was increased, the rate of satisfactory sedation was increased, the incidence of agitation, nausea and vomiting was decreased, the serum blood urea nitrogen, creatinine and cystatin C concentrations were decreased, and the urine volume was increased at each time point after surgery（P〈0.05）, and no significant change was found in the degree of agitation or incidence of pruritus in group OD（P〉0.05）.Conclusion PCIA with oxycodone mixed with dexmedetomidine provides reliable efficacy and higher safety when used for analgesia after combined pancreas-kidney transplantation and is helpful in promoting recovery of the function of the transplanted kidney.