摘要
目的评价右美托咪啶混合舒芬太尼用于剖宫产术后病人自控静脉镇痛（PCIA）的效果。方法择期脊椎一硬膜外麻醉下行剖宫产术病人120例，年龄18—40岁，身高155—170cm，采用随机数字表法，将病人随机分为3组（n=40）：Ⅰ组于胎儿娩出后静脉注射生理盐水20ml，术后采用舒芬太尼进行PCIA（背景输注速率0．015μg·kg^-1·h^-1，PCA量0．023μg/kg，锁定时间8min）；Ⅱ组于胎儿娩出后静脉注射右美托咪啶0．5μg／kg，术后PCIA同Ⅰ组；Ⅲ组术中处理同Ⅱ组，术后采用舒芬太尼混合右美托咪啶进行PCIA（舒芬太尼背景输注速率0．015μg·kg^-1·h^-1，右美托咪啶背景输注速率0．045μg·kg^-1·h^-1，舒芬太尼PCA量0．023μg／kg、右美托咪啶PCA量0．07μg／kg，锁定时间8min）。于麻醉前和输注右美托咪啶1h时测定痛阈和耐痛阈，于术后4、8、24h时记录VAS评分、警觉／镇静评分和舒芬太尼用量，于术后3h时记录恶露排出量，记录泌乳发动时间，于术后24h时行病人满意度评价，于麻醉前和输注右美托咪啶1h、术后24h时采集外周静脉血样，采用双抗体夹心酶联免疫吸附法测定血清皮质醇浓度，记录不良反应的发生情况。结果与Ⅰ组比较，Ⅱ组和Ⅲ组输注右美托咪啶1h时痛阈和耐痛阈升高，Ⅲ组术后4、8、24h时VAS评分和舒芬太尼用量降低，病人满意度升高（P〈0．05）；与Ⅱ组比较，Ⅲ组术后4、8、24h时VAS评分和舒芬太尼用量降低，Ⅲ组病人满意度升高（P〈0．05）；其余指标组间比较差异无统计学意义（P〉0．05）。结论右美托咪啶混合舒芬太尼用于剖宫产术后PCIA的效果优于单独应用舒芬太尼。
Objective To evaluate the efficacy of dexmedetomidine combined with sufentanil for patientcontrolled intravenous analgesia （PCIA） after caeserean section. Methods One hundred and twenty parturients aged 18-40 yr undergoing caeserean section under spinal-epidural anesthesia were randomly assigned to one of 3 groups （ n = 40 each） ： group Ⅰ , group Ⅱ and group Ⅲ . During operation as soon as the baby was born a bolus of dexmedetomidine 0.5 μg/kg was given iv in Ⅱ and Ⅲ groups while in group Ⅰ normal saline （NS） was given instead. Ⅰ and Ⅱ groups received PCIA with sufentanil （background infusion 0.015 μg·kg^-1·h^-1 ; bolus dose 0.023 μg/kg; lockout interval 8 min）. Group Ⅲ received PCIA with sufentanil ＋ dexmedetomidine （background infusion sufentanil 0. 015 μg·kg^-1·h^-1 ＋ dexmedetomidine 0. 045 μg·kg^-1·h^-1 ; bolus dose sufentanil 0. 023 μg/kg ＋ dexmedetomidine 0.07 μg/kg; lockout interval 8 min）. Pain threshold and pain tolerance threshold were measured before caeserean section and 1 h after bolus dose of dexmedetomidine or NS. VAS, OAA/S and satisfaction scores and sufentanil consumption were recorded at 4, 8 and 24 h after operation. Blood samples were obtained before anesthesia, 1 h after bolus injection of dexmedetomidine, and 24 h after operation for determination of serum cortisol concentration. Results Pain threshold and pain tolerance threshold at 1 h after bolus injection of dexme- detomidine were significantly increased as compared with the baseline before anesthesia in Ⅱ and Ⅲ groups and were significantly higher in Ⅱ and Ⅲ groups than in group Ⅰ. VAS scores and the consumption of sufentanil were significantly lower while the satisfactory score was significantly higher in group Ⅲ than in Ⅰ and Ⅱ groups. Serum cortisol concentrations were significantly increased at 1 h after iv dexmedetomidine or NS injection as compared with the baseline before anesthesia in all 3 groups, but there was no significant difference in serum cortisol levels among the 3 groups. Conclusion Addition of dexmedetomidine to sufentanil for PCIA can significantly reduce the consumption of sufentanil and improve parturient＇ s satisfaction.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2011年第3期274-277,共4页
Chinese Journal of Anesthesiology
基金
复旦大学上海医学院青年骨干基金
关键词
右美托咪啶
舒芬太尼
镇痛
病人控制
剖宫产术
疼痛
手术后
Dexmedetomidine
Sufentanil
Analgesia, patient-controlled
Caesarean section
Pain postoperative
