右旋美托咪定复合舒芬太尼在断指再植术后静脉镇痛中的应用

Postoperative patient controlled intravenous analgesia with dexmedetomidine combined with sufentanil in patients undergoing finger replantation

目的观察右旋美托咪定复合舒芬太尼在断指再植术后静脉镇痛中的效果。方法选取2017年1月至2018年1月期间在本院接受断指再植术的120例患者作为研究对象,随机分成观察组60例和对照组60例。麻醉方式采用高频超声引导下行肌间沟复合腋路臂丛。术后行静脉自控镇痛。对照组采用舒芬太尼镇痛:2μg/kg舒芬太尼+生理盐水至100 ml;观察组在对照组基础上加用右美托咪定:2μg/kg舒芬太尼+2μg/kg右美托咪定+生理盐水至100 ml。两组首次剂量为2 ml,设置背景输注量为2 ml/h,自控输注量0.5 ml/次,自控时间锁定15 min。评价两组患者术后VAS评分、Ramsay评分、48 h PCA键按压次数及舒芬术尼用量。结果观察组术后4 h、12 h、24 h、48 h VAS评分分别为(3.5±1.4)、(4.0±1.5)、(3.2±0.3)、(2.5±0.7),对照组对应时点VAS评分分别为(4.7±1.8)、(5.1±1.7)、(4.9±1.4)、(3.8±1.1),两组相比差异有统计学意义(P<0.05);观察组术后4 h、12 h、24 h、48 h Ramsay评分分别为(2.6±0.4)、(3.1±1.4)、(2.9±0.5)、(3.6±0.3),对照组相应时点分别为(2.2±0.7)、(2.4±1.1)、(2.7±0.2)、(3.2±0.8),两组相比差异有统计学意义(P<0.05);观察组术后48 h PCA键按压次数(20.6±5.4)及舒芬太尼用量(81.75±21.69)μg明显少于对照组按压次数(26.3±4.7)及舒芬太尼用量(101.22±20.38)μg(P<0.01);观察组恶心呕吐、头晕、皮肤瘙痒等不良反应总发生率(6.7%)与对照组(20%)相比,差异有统计学意义(P<0.05)。结论右美托咪定复合舒芬太尼对断指再植术患者术后镇痛效果确切,并且减少不良反应的发生率。

Objective To evaluate the efficacy of postoperative patient controlled intravenous analgesia(PCIA)with dexmedetomidine combined with sufentanil in patients undergoing finger replantation.Methods 120 patients undergoing finger replantation in our hospital from January 2017 to January 2018 were randomly divided into control group(60 cases)and observation group(60 cases).The brachial plexus nerve block was induced by high frequency ultrasound in both groups.The PCIA formulation in the control group was 2μg/kg sufentanil in 100 ml normal saline,and the PCIA formulation in the observation group was 2μg/kg sufentanil and 2μg/kg dexmedetomidine in 100 ml normal saline.All patients received PCIA after operation with the background infusion rate 2 ml/h,the bolus infusion rate 0.5 ml/time,and lockout time 15 minutes.VAS score,Ramsay sedation score at 4,12,24,48 h after surgery,the number of PCA key presses,sufentanil dosage,and the adverse effects were recorded.Results VAS scores of the observation group at 4 h,12 h,24 h,and 48 h after surgery were(3.5±1.4),(4.0±1.5),(3.2±0.3),and(2.5±0.7),respectively,the corresponding VAS scores of the control group were(4.7±1.8),(5.1±1.7),(4.9±1.4),and(3.8±1.1),respectively,and there were statistically significant differences between the two groups(P<0.05).Ramsay scores in the observation group at 4 h,12 h,24 h,and 48 h after surgery were(2.6±0.4),(3.1±1.4),(2.9±0.5),and(3.6±0.3),the corresponding Ramsay scores in the control group were(2.2±0.7),(2.4±1.1),(2.7±0.2),and(3.2±0.8),respectively,and there were statistically significant differences between the two groups(P<0.05).The number of PCA key presses[(20.6±5.4)times]and sufentanil dosage[(81.75±21.69)μg]in the observation group were significantly lower than those in the control group[(26.3±4.7),(101.22±20.38)μg](P<0.01).The total incidence of nausea and vomiting,dizziness,itching,and other adverse reactions in the observation group(6.7%)was significantly lower than that in the control group(20%)(P<0.05).Conclusion PCIA with dexmedetomidine combined with sufentanil is effective for patients undergoing finger replantation,which can decrease the incidence of adverse events.