右美托咪定复合舒芬太尼对老年髋关节置换手术睡眠质量的影响

The effect of dexmedetomidine combined with sufentanil in elderly patients undergoing hip replacement surgery

目的探讨右美托咪定复合舒芬太尼对老年髋关节置换患者术后睡眠质量的影响。方法选择行髋关节置换手术的老年患者90例,男42例,女48例,年龄71~92岁,BMI 18.4~23.5 kg/m ^(2),ASAⅡ级或Ⅲ级。随机分为2组,右美托咪定2μg/kg+舒芬太尼2μg/kg+托烷司琼5 mg组(DS组)和舒芬太尼2μg/kg+托烷司琼5 mg(S组)。所有患者麻醉诱导前10 min给予右美托咪定负荷量0.7μg/kg静脉泵入,10 min后改为0.3~0.5μg/kg,麻醉诱导:静脉注射咪达唑仑0.03~0.05 mg/kg、舒芬太尼0.3~0.5μg/kg、依托咪酯0.1~0.3 mg/kg,于手术结束前30 min停用右美托咪定,结束前10 min停麻醉药物,静脉注射甲磺酸托烷司琼5 mg、氟比洛芬酯50 mg,同时接静脉镇痛泵行术后患者自控静脉镇痛(PCIA),背景输注流速2~3 mL/h,单次追加量为0.5 mL,锁定时间15 min,镇痛持续48 h,药物配制总容量为150 mL。于术后2 h(T_(0))、4 h(T_(1))、8 h(T_(2))、12 h(T_(3))、24 h(T_(4))、48 h(T_(5))分别记录VAS评分、Ramsay镇静评分和术后不良反应情况。于术前、术后24、48 h,出院前和术后3个月进行匹兹堡睡眠质量指数(PSQI)评分。结果T_(2)~T_(4)时DS组VAS评分明显低于S组(P<0.05)。T_(2)~T_(4)时DS组Ramsay镇静评分明显高于S组(P<0.05)。术后24、48 h和出院前DS组PSQI评分明显低于S组(P<0.05)。2组不良反应发生率差异无统计学意义。结论右美托咪定复合舒芬太尼可更有效改善老年髋关节置换患者术后睡眠质量,降低了PSQI评分,睡眠质量改善作用优于单纯应用舒芬太尼。

Objective To investigate the effect of dexmedetomidine combined with sufentanil on the quality of sleep in elderly patients with hip replacement.Methods A total of 90 elderly patients undergoing hip replacement surgery were enrolled.The patients were randomly divided into DS group and S group.In group DS,the patients were given dexmedetomidine 2μg/kg+sufentanil 2μg/kg+tropisetron 5 mg,and in group S,the patients were given sufentanil 2μg/kg+tropisetron 5 mg.All patients were given loading dose of dexmedetomidine 0.7μg/kg intravenously 10 minutes before anesthesia induction,and then 0.3~0.5μg/(kg·h)were continuously intravenous injected after 10 minutes.The dexmedetomidine was stopped 30 minutes before the end of the operation,and the anesthetic was stopped 10 minutes before the end of surgery.Intravenous injection of tropisetron mesylate 5 mg,flurbiprofen axetil 50mg,simultaneous intravenous analgesia pump,patient-controlled intravenous analgesia(PCIA)was used for postanalgesia.VAS score,Ramsay sedation score and postoperative adverse reactions were recorded at 2 h(T_(0)),4 h(T_(1)),8 h(T_(2)),12 h(T_(3)),24 h(T_(4))and 48 h(T_(5)).The Pittsburgh Sleep Quality Index(PSQI)score was performed before surgery,24,48 hours after surgery,before discharge,and at 3 months after surgery.Results The VAS scores of patients in group DS were significantly lower than those of patients in group S at T_(2)~T_(4)(P<0.05).The Ramsay sedation score of DS group was significantly higher than that of patients in group S at T_(2)~T_(4)(P<0.05).The PSQI scores of patients in group DS at 24 and 48 h after surgery and before discharge were significantly lower than those in the S group(P<0.05).Conclusion Dexmedetomidine combined with sufentanil can effectively improve postoperative sleep quality and reduce PSQI score of elderly patients with hip replacement,which is better than sufentanil used alone.