不同剂量右美托咪啶复合舒芬太尼在老年肱骨骨折术后自控静脉镇痛中的应用效果

Application effect of different doses of dexmedetomidine combined with sufentanil inpatient–controlled intravenous analgesia after senile humeral fracture surgeryin elderly patients

目的 探讨不同剂量右美托咪定复合舒芬太尼在老年肱骨骨折术后患者自控静脉镇痛(patient–controlled intravenousanalgesia,PCIA)中的应用效果。方法 回顾性分析2021年1月至12月赣州市中医院收治的80例患者,根据治疗方法不同将其分为A、B、C、D组,每组各20例。A组患者给予右美托咪啶1μg/kg+舒芬太尼2μg/kg+托烷司琼10mg治疗,B组患者给予右美托咪定1.5μg/kg+舒芬太尼2μg/kg+托烷司琼10mg治疗,C组患者给予右美托咪定2μg/kg+舒芬太尼2μg/kg+托烷司琼10mg治疗,D组患者给予舒芬太尼2μg/kg+托烷司琼10mg治疗。比较4组患者的术后疼痛视觉模拟评分(visual analogue scale,VAS)情况、PCIA按压次数和药物用量、不良事件发生情况、镇静情况。结果 术后疼痛VAS结果显示,A、B、C组的术后疼痛VAS均低于D组,且B组疼痛VAS低于A、C组,差异均有统计学意义(P<0.05)。舒芬太尼用药总量、PCIA按压次数分析显示,相比于D组,A、B、C组更少,且A、C组均高于B组,差异均有统计学意义(P<0.05)。不良事件发生率分析显示,相比于D组,A、B、C组的占比更低,相比于B组,A、C组占比更高,差异均有统计学意义(P<0.05)。镇痛程度评估表(Richmond agitation–sedation scale,RASS)评分显示,相比于A组,B、C、D组RASS评分更低,且C组评分低于B、D组,差异均有统计学意义(P<0.05)。结论 对于接受手术治疗的老年肱骨骨折患者,给予右美托咪啶复合舒芬太尼干预可显著提高术后镇痛效果,减少PCIA按压次数,减少舒芬太尼用量及不良事件发生率,且中剂量右美托咪啶镇静和镇痛效果更优。该术后自控静脉镇痛方案疗效确切,可在临床中推广。

Objective To investigate the efficacy of dexmedetomidine combined with sufentanil in patients with patient–controlled intravenous analgesia(PCIA) after humeral fracture in the elderly. Methods 80 patients admitted to Ganzhou Hospital of Traditional Chinese Medicine from January to December 2021 were retrospectively analyzed, they were divided into groups A, B, C and D according to the treatment method, 20 cases in each group. Group A was treated with dexmedetomidine 1μg/kg+ sufentanil 2μg/kg+ tropisetron 10mg, group B was treated with dexmedetomidine 1.5μg/kg+sufentanil 2μg/kg+ tropisetron 10mg, group C was treated with dexmedetomidine 2μg/kg+ sufentanil 2μg/kg+ tropisetron 10mg, Group D was given sufentanil 2μg/kg+ tropisetron 10mg. The postoperative pain visual analogue scale(VAS), the number of PCIA compressions and drug dosage, the incidence of adverse events and sedation of 4 groups were compared.Results Postoperative VAS score analysis showed that the postoperative VAS score of group A, B and C was lower than that of group D, and the VAS score of group B was lower than that of group A and C, the differences were statistically significant(P<0.05). Analysis of the total amount of sufentanil used and the number of PCIA presses showed that compared with group D, there were fewer sufentanil used in group A, group B and group C, and group A and group C were higher than group B, with statistical significance(P<0.05). Analysis of the incidence of adverse events showed that compared with group D, the proportion of group A, B and C was lower, and the proportion of group A and C was higher than that of group B, with statistical significance(P<0.05). Richmond agitation–sedation scale(RASS) score(analgesic degree evaluation table) showed that compared with group A, The RASS score of groups B, C and D was lower, and the score of group C was lower than that of group B and D, with statistical significance(P<0.05). Conclusion Dexmedetomidine combined with sufentanil can significantly improve postoperative analgesia, reduce the number of PCIA presses,and reduce the dosage of sufentanil and the incidence of adverse events in elderly patients with humeral fractures undergoing surgical treatment. The sedative and analgesic effects of medium dose dexmedetomidine were better. This postoperative self–controlled intravenous analgesia scheme is effective and recommended to be widely used in clinic.