摘要
目的考察右美托咪定联合舒芬太尼对老年患者骨科手术术后镇痛的影响,探讨其用于老年患者术后镇痛的最佳剂量。方法将该院2014年10月至2016年5月进行骨科手术的120例老年患者随机分为4组,各30例。舒芬太尼组(SF组):术后镇痛予以舒芬太尼1.0μg/(kg·d)+昂丹司琼8 mg;低剂量右美托咪定组(D1组):术后镇痛予以舒芬太尼1.0μg/(kg·d)+昂丹司琼8 mg+右美托咪定0.5μg/(kg·d);中剂量右美托咪定组(D2组):术后镇痛予以舒芬太尼1.0μg/(kg·d)+昂丹司琼8 mg+右美托咪定1.0μg/(kg·d);高剂量右美托咪定组(D3组):舒芬太尼1.0μg/(kg·d)+昂丹司琼8 mg+右美托咪定1.5μg/(kg·d)。各组用药均以生理盐水配成150 mL。术毕停药后行经静脉自控镇痛(PCIA),记录术后1 h(T1)、2 h(T2)、6 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)的视觉模拟评分(VAS评分),Ramsay镇静评分、按压次数、平均动脉压与心率。观察并记录不良反应。结果 D2、D3组各时间点VAS评分、Ramsay评分、平均动脉压与心率均低于SF组,D1、D2、D3组自控按压次数较SF组明显降低,差异均有统计学意义(P<0.05)。D2组各时间点VAS评分均低于D1组,差异有统计学意义(P<0.05);而D2组与D3组比较,差异无统计学意义(P>0.05)。D1组T1~T3的VAS评分均低于SF组,差异有统计学意义(P<0.05)。Ramsay评分与心率,D1、D2、D3组组间比较,差异均有统计学意义(P<0.05)。SF组恶心呕吐发生率明显高于D1、D2、D3组,D3组心动过缓发生率明显高于D1、D2、SF组,差异均有统计学意义(P<0.05)。结论右美托咪定联合舒芬太尼用于术后镇痛效果确切,不良反应少,推荐用于老年患者术后镇痛的右美托咪定剂量为1.0μg/(kg·d)。
Objective To investigate the effect of dexmedetomidine combined with sufentanil on postoperative analgesia in elderly patients undergoing orthopaedic surgery and to investigate the optimal dose for postoperative analgesia in elderly patients. Methods 120 elderly patients from October 2014 to May 2016 were randomly assigned into 4 groups. Sufentanil group（SF group）：using sufentanil 1.0 μg/（kg·d）＋ ondansetron 8 mg for postoperative analgesia. Low-dose dexmedetomidine group（D1 group）：using sufentanil 1.0 μg/（kg·d）＋ ondansetron 8 mg ＋ dexmedetomidine 0.5 μg/（kg·d）for postoperative analgesia. Mid-dose dexmedetomidine group（D2 group）：using sufentanil 1.0 μg/（kg·d）＋ ondansetron 8 mg ＋ dexmedetomidine1.0 μg/（kg·d）for postoperative analgesia. High-dose dexmedetomidine group（D3 group）：using sufentanil 1.0 μg/（kg·d）＋ondansetron 8 mg ＋ dexmedetomidine 1.5 μg/（kg·d）for postoperative analgesia. Each group of medications were formulatedwith physiological saline into 150 mL of solution. After completion of surgery and withdrawal of medication,intravenous patient-controlled analgesia（PCIA）was used. Visual analogue scale（VAS）,Ramsay sedation score,number of presses,mean arterialpressure and heart rate were recorded at 1 h（T1）,2 h（T2）,6 h（T3）,12 h（T4）,24 h（T5）,and 48 h（T6）after surgery.Adverse reactions were observed and recorded. Results The VAS score,Ramsay score,mean arterial pressure,and heart ratewere lower in the D2 group and D3 group than that in the SF group,and the number of self-control presses in D1 group,D2 group and D3 group were significantly lower than that in SF group,the differences were statistically significant（P〉0.05）. TheVAS score of D2 group was lower than that of D1 group at each time point,the difference weres statistically significant（P〈0.05）;but there was no significant difference between D2 and D3 groups（P〈0.05）. The VAS scores of T1 to T3 in D1 groupwere lower than those in SF
作者
李蒙新
张春梅
朱蓉
熊朝晖
LI Mengxin;ZHANG Chunmei;ZHU Rong;XIONG Zhaohui(Department of Anesthesiology, Guang′ an People′ s Hospital,Guang′an, Sichuan 638000, Chin)
出处
《现代医药卫生》
2018年第10期1488-1491,共4页
Journal of Modern Medicine & Health
关键词
右美托咪定
舒芬太尼
镇痛
麻醉
Dexmedetomidine
Sufentanil
Analgesia
Anesthesia
