摘要
目的:探讨右美托咪定用于老年患者下肢手术后舒芬太尼自控静脉镇痛(PCIA)的适宜剂量和安全性。方法:将2014年1月至2015年12月收治的120例髋部及股骨骨折内固定术后PCIA患者随机分4组:对照组(S组,舒芬太尼100μg)和D1组(右美托咪定0.5μg/kg+舒芬太尼100μg)、D2组(右美托咪定1.0μg/kg+舒芬太尼100μg)、D3组(右美托咪定1.5μg/kg+舒芬太尼100μg),每组各30例。观察术后4、8、24、48 h NRS评分、术后48 h按压次数及舒芬太尼用量、不良反应等。结果:(1)与S组比较,D1、D2和D3组术后4、8、24 h静态和动态NRS评分均较低(P<0.05);D2、D3组术后48 h动态NRS评分均较低(P<0.05)。与D1组比较,D2、D3组术后4、8、24 h静态NRS评分均较低(P<0.05);D2、D3组术后4个时相点动态NRS评分均较低(P<0.05)。S组、D1组术后4个时相点动态NRS评分均较同组静态NRS评分升高(P<0.05)。(2)与S组相比,D1、D2和D3组按压次数和舒芬太尼用量均较少(P<0.05)。与D1组比较,D2、D3组按压次数和舒芬太尼用量均较少(P<0.05)。与D2组比较,D3组按压次数和舒芬太尼用量较少(P<0.05)。(3)不同剂量右美托咪定与舒芬太尼用量存在线性负相关(r=-0.9879,P<0.05),但大剂量右美托咪定(1.5μg/kg)对减少舒芬太尼用量的效果不再明显。(4)与S组相比,D1、D2组不良反应发生率明显降低(P<0.05)。结论:右美托咪定联合舒芬太尼用于老年患者下肢手术后患者自控静脉镇痛时推荐剂量以1.0μg/kg为宜,镇痛效果确切,不良反应发生率低。
Objective：To investigate the optimal dose and safety profile of Dexmedetomidine in elderly after lower limb surgery who receive patient controlled intravenous analgesia （ PCIA） with Sufentanil. Methods：A total of 120 patients who received PCIA after internal fixation of hip and femoral fractures between January 2014 and December 2015 were randomly divided into four groups：control group （ S group, Sufentanil 100μg ） , D1 group （Dexmedetomidine 0.5 μg/kg ＋ Sufentanil 100μg）,D2 group （Dexmedetomidine 1.0 μg/kg＋Sufentanil 100μg） ,D3 group （ Dexmedetomidine 1.5 μg/kg ＋ Sufentanil 100μg） （ n=30 each） . We recorded the NRS scores at 4,8,24,and 48 hrs after surgery,48h pressing times and dosage of Sufentanil,and adverse reactions. Results：（1） Compared with S group,D1,D2 and D3 groups had lower static and dynamic NRS scores at 4,8,and 24 h postoperatively （ P〈0.05）;D2 and D3 groups had lower dynamic NRS scores at 48h postoperatively （ P〈0.05） . Compared with the group D1,the D2 and D3 groups had lower static NRS scores at 4,8,and 24 h postoperatively （P〈0.05） and lower dynamic NRS scores at all the four time points （P〈0.05 ）. Within either S group or D1 group,dynamic NRS scores were higher than static NRS scores at any of the four time points （ P〈0. 05 ） . （ 2） Compared with S group, the D1, D2 and D3 groups showed less pressing times and dosage of Sufentanil （ P〈0.05）;compared with the D1 group,D2 and D3 groups showed less pressing times and dosage of Sufentanil （ P〈0.05）;compared with D2 group,the D3 group showed less pressing times and dosage of Sufentanil （P〈0.05）. （ 3） There was a linear negative correlation in doses between Dexmedetomidine and sufentanil （ r=-0. 9879, P〈0.05）;however,very high dose of Dexmedetomidine （1.5 μg/kg） was not shown to significantly reduce the use of Sufentanyl. （4） Compared with S group,D1 and D2 groups were found to have significantly less adverse events （ P〈0.05） . Conclusion：1.0μg/kg Dexmedetomidine is the recommended dose when used in combination with Sufentanil for PCIA in elderly after lower limb surgery. Such a dose may result in reliable analgesic effect and low incidence of adverse reactions.
出处
《广州医科大学学报》
2016年第2期13-17,共5页
Academic Journal of Guangzhou Medical University
基金
广东省科技计划项目(2013B090500113)
关键词
右美托咪定
舒芬太尼
量效关系
老年
自控静脉镇痛
Dexmedetomidine
Sufentanil
dose-effect relationship
elderly
patient controlled intravenous analgesia
