摘要
目的评价右美托咪定联合舒芬太尼用于腰椎融合术后静脉自控镇痛的效果。方法拟在全身麻醉下行腰椎融合术病人60例,男女不限,ASA分级Ⅰ~Ⅱ级,年龄32~65岁,体重47、82、g,术后均采用静脉自控镇(PCIA),采用随机数字表法,将PCIA用药随机分为2组:单纯舒芬太尼组(S组,n=30)和右美托咪定联合舒芬太尼组(SD组,n=30)。S组术毕前30min经静脉注射0.9%生理盐水25ml,SD组术毕前30min静脉注射含右美托咪定0.5μg·kg^(-1)的生理盐水25ml。术后转入麻醉苏醒室(PACU)观察,所有病人术毕即给予PCIA用药:S组2.5μg.kg^(-1)舒芬太尼加0.9%生理盐水至250ml;SD组右美托咪定3μg·kg^(-1)与舒芬太尼2.5μg.kg^(-1)加0.9%生理盐水至250ml。PCIA设置为背景量4.0ml·h^(-1),指令量2.5ml,锁定时间15min。于术前和术后6、12、24、36及48h记录静态时VAS和Ramsay评分,于术后24h、36和48h记录动态VAS评分。并记录有关不良反应发生情况。结果 SD组术后静态、动态时VAS评分均比S组明显降低(P<0.05)。与术前比较,S组在术后24h后的VAS评分均明显降低(P<0.05);SD组术后48h内的静态VAS和动态VAS评分均明显降低(P<0.05),SD组术后48h内Ramsay镇静评分均明显提高(P<0.05),且比S组提高显著(P<0.05)。自评满意度调查,SD组明显优于S组。两组均未见有关不良反应发生。结论 PCIA舒芬太尼联合右美托咪定可明显改善腰椎融合手术病人术后镇痛效果和病人满意度。
Objective To investigate the efficacy of dexmedetomide combined with sufentanfl on intravenous patient-controlled analgesia in lumbar spondylodesis patients after surgery. Methods Sixty patients with segmental lumbar instability and degenerative spondylolisthesis for lunmbar spondylodesis under general anesthesia, aged 32-65 years, weighing 47-82 kg, ASA I to II, were randomly divided into two groups （n=30 each group）. S group received IV 25 ml physiological saline at 30 minutes before the end of surgery; SD group received IV 0.5 μg·kg-1 dexmedetomidine diluted to 25 ml physiological saline at 30 minutes before the end of surgery. Patients hospitalized at the post anesthetic care unit and a standard PCIA protocol was adopted, which S group was consisted of 2.5μg·kg-1 sufentanil diluted into 250 ml; and SD group was 2.5 μg·kg-1 sufentanil and 3.0μg·kg-1 dexmedetomidine diluted to 250 ml, and administered at a background dose of 4ml·h- 1 and a bolus dose of 2.5 ml each, with a lock-out of 15 minutes in two groups. Pain and sedation was scored at rest using Visual Analog Scale （VAS） and Ramsay scale were determined before surgery, and 6, 12, 24, 36 and 48 h after surgery respectively. Pain was scored during continuous passive motion using VAS at 24, 36 and 48 h after surgery. Side effects were also recorded in both groups. Results VAS score was significantly lower at rest and during continuous passive motion in SD group than that in S group （P 〈 0.05 ）. Compared with baseline value, VAS score decreased significantly at 24 after surgery in S group and duration of surgery in SD group （P 〈 0.05））. Ramsay score increased significantly during postoperative analgesia in SD group, and was significantly higher than in S group （P 〈 0.05））. More patients in group SD were satisfied with the PCIA analgesic compared with group S. Conclusion The combination of sufentanil and dexmedetomidine for postoperative PCIA can improve pain control and improve postoperative patient＇s satisfaction compared with sufentanil alone in PCIA.
出处
《新疆医学》
2017年第1期47-50,共4页
Xinjiang Medical Journal
关键词
右美托咪啶
舒芬太尼
术后静脉自控镇痛
腰椎融合术
Dexmedetomidine
Sufentanil
Postoperative intravenous patient-controlled analgesia
Lumbar spondylodesis
