右美托咪定混合舒芬太尼用于双肺移植术后病人自控静脉镇痛的效果

Efficacy of dexmedetomidine mixed with sufentanil for patient-controlled intravenous analgesia after double lung transplantation

目的评价右美托咪定混合舒芬太尼用于双肺移植术后病人自控静脉镇痛的效果。方法择期行双肺移植术病人32例，性别不限，年龄33-64岁，ASA分级Ⅲ或Ⅳ级，体重指数18-29kg／m^2，采用随机数字表法分为2组（n=16）：舒芬太尼组（s组）和右美托咪定混合舒芬太尼组（Ds组）。两组术后均行病人自控静脉镇痛，s组配方为舒芬太尼3．0μg／kg＋托烷司琼10mg；DS组配方为舒芬太尼3．0μg／kg＋右美托咪定1．0μg／kg＋托烷司琼10mg，均用生理盐水配至100ml。维持术后镇痛期间的VAS评分≤3分，当VAS评分≥4分时静脉给予舒芬太尼5μg进行补救镇痛。记录补救镇痛及不良反应的发生情况；于术毕（T0）、术后2、4、8、24和48h（T1-5）时测定肺动脉压力。结果与S组比较，Ds组补救镇痛率、恶心呕吐发生率和T1-5时肺动脉压力降低（P〈0．05）。结论右美托咪定混合舒芬太尼用于双肺移植术后病人自控静脉镇痛效果较好，不良反应少，且可降低肺动脉压力。

Objective To evaluate the efficacy of dexmedetomidine mixed with sufentanil for pa-tient-controlled intravenous analgesia （PCIA） after double lung transplantation. Methods Thirty-two pa-tients of both sexes, aged 33-64 yr, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ, with body mass index of 18-29 kg/m2, were divided into 2 groups （n= 16 each） using a random number table： sufentanil group （group S） and dexmedetomidine mixed with sufentanil group （group DS）. PCIA was performed after operation in both groups. The PCIA solution contained sufentainl 3.0 μg/kg and tropise-tron 10 mg (diluted to 100 ml in normal saline） in group S and sufentainl 3.0 μg/kg, dexmedetomidine 1.0 μg/kg and tropisetron 10 mg （diluted to 100 ml in normal saline） in group DS. Visual analogue scale score was maintained less than or equal to 3 during postoperative analgesia period, and sufentainl 5 μg was intravenously injected when visual analogue scale score was more than or equal to 4. The requirement for rescue analgesics and development of adverse reactions were recorded. The pulmonary arterial pressure was recorded at the end of surgery (T0) and at 2, 4, 8, 24 and 48 h after surgery (T1-5). Results Com-pared with group S, the requirement for rescue analgesics, incidence of nausea and vomiting and pulmonary arterial pressure at T1-5 were significantly decreased in group DS （P〈 0. 05）. Conclusion Dexmedetomi-dine mixed with sufentanil produces better efficacy for PCIA with fewer adverse reactions and decreases the pulmonary arterial pressure after double lung transplantation.