右美托咪定联合舒芬太尼用于老年胸外科手术患者术后镇痛的疗效观察

Postoperative analgesia effect of dexmedetomidine combined with sufentanil on elderly patients with thoracic surgery

目的探讨右美托咪定联合舒芬太尼对老年胸外科手术患者镇痛、睡眠质量及安全性的影响。方法选择在内蒙古医科大学附属医院行开胸手术且术后72 h内接受术后镇痛的老年患者(年龄≥60岁)58例,按照随机数字表法分为对照组和右美托咪定组(各29例)。比较2组患者舒芬太尼累积消耗量、疼痛数字评分法(NRS)评分、主观睡眠质量NRS评分以及相关不良反应(包括高血压、低血压、心动过速、心动过缓、恶心呕吐等)等。结果对照组舒芬太尼消耗量大于右美托咪定组[(220±7)μg比(191±8)μg],差异有统计学意义(P<0.01)。术后4、24、48、72 h静息状态和运动状态右美托咪定组患者NRS评分均高于对照组,差异均有统计学意义(均P<0.05)。右美托咪定组高血压1例,低血压7例,术后恶心呕吐3例,术后躁动1例;对照组高血压2例,低血压8例,术后恶心呕吐11例,2组不良反应发生率比较差异均无统计学意义(均P>0.05)。结论对于接受胸外科手术的老年患者,右美托咪定与舒芬太尼联合用于术后镇痛,可以显著减少舒芬太尼的使用量,提高镇痛效果,可改善患者的睡眠质量。

Objective To investigate the safety and effect of dexmedetomidine combined with sufentanil on postoperative analgesia and sleep quality in elderly patients with thoracic surgery. Methods A total of 58 elderly patients(≥60 years old) undergoing thoracotomy in the Affiliated Hospital of Inner Mongolia Medical University were randomly divided to have different analgesia regimens in 72 h after surgery(control group vs dexmedetomidine group,n = 29). Consumption of sufentanil,scores of pain and sleep quality assessed by numerical rating scale(NRS),adverse reactions including hypertension, hypotension, tachycardia, bradycardia, nausea and vomiting were analyzed.Results Consumption of sufentanil in the control group was significantly more than that in the dexmedetomidine group[(220 ±7)μg vs(191 ±8)μg](P <0. 01). NRS scores at 4,24,48,72 h after surgery in the dexmedetomidine group were significantly higher than those in the control group(all P < 0. 05). In dexmedetomidine group there were 1 case of hypertension,7 cases of hypotension,3 cases of nausea and vomiting and 1 case of agitation. In control group there were 2 cases of hypertension,8 cases of hypotension,11 cases of nausea and vomiting. There was no significant difference in the incidence of adverse reactions between groups( all P > 0. 05). Conclusion Dexmedetomidine combined with sufentanil can effectively improve postoperative analgesia effect,reduce dosage of sufentanil and improve sleep quality in elderly patients undergoing thoracic surgery.