右美托咪定复合曲马多用于老年高血压患者术后镇痛的效果

目的观察右美托咪定复合曲马多对原发性高血压老年患者术后镇痛的效果。方法选择择期气管插管静吸复合全身麻醉下行骨折内固定手术患者60例,年龄65～79岁,体重50～75 kg,高血压分级Ⅰ或Ⅱ级。采用随机数字表法,将患者随机分成3组(每组20例):Ⅰ组术毕前30 min静注曲马多50 mg,术后采用曲马多PCIA,配方为曲马多500 mg+托烷司琼5 mg+生理盐水稀释至100 mL,背景输注速率2 mL/h,PCIA0.5 mL,锁定时间15 min;Ⅱ组术毕前40 min缓慢输注右美托咪定0.4μg/kg,术后PCIA同Ⅰ组;Ⅲ组术毕前40min静滴右美托咪定0.4μg/kg,术后采用曲马多400 mg复合右美托咪定100μg行PCIA。记录术后24 h内VAS评分和曲马多用量、Ramsay镇静评分、呕吐和呼吸抑制的发生情况及三组患者的BP、HR和乌拉地尔、麻黄碱和阿托品的使用情况。于术后24 h时行患者满意度评价。结果与Ⅰ组相比,Ⅱ组和Ⅲ组术后24 h内曲马多用量和VAS评分降低,Ramsay镇静评分和满意度评价升高,呕吐发生率和乌拉地尔使用率降低(P<0.05);与Ⅱ组相比,Ⅲ组术后24 h内曲马多用量、VAS评分及乌拉地尔使用率降低,Ramsay镇静评分升高(P<0.05)。结论小剂量右美托咪定复合曲马多PCIA用于老年高血压患者术后镇痛安全、有效,还可预防术后高血压进一步恶化。

Effect of dexmedetomidine combined with tramadol for patient-controlled intravenous analgesia on elderly patients with essential hypertension

Objective To evaluate the efficacy of dexmedetomidine combined with tramadol for patient-controlled intravenous analgesia on elderly patients with essential hypertension.Methods 60 ASA Ⅰ~Ⅱ elderly patients with essential hypertension,aged 65~79 year-old undergoing elective internal fixation of femoral shaft fracture under general anesthesia were randomly divided into 3 groups(20 cases in each group):groupⅠ,group Ⅱ and group Ⅲ.Dexmedetomidine 0.4 μg/kg was injected intravenously 40 min before operation ending in group Ⅱand Ⅲ while tramadol 50 mg was given in group Ⅰ.GroupⅠand groupⅡ received PCIA with tramadol 500 mg + tropisetron 5 mg in 100 mL of normal saline(background infusion at 2 mL/h with 0.5 mL and lockout interval 15 min)within 24 h after operation.Group Ⅲ received PCIA with tramadol 400 mg combined with dexmedetomidine 100 μg and tropisetron 5mg in 100 mL of normal saline respectively.VAS scores,tramadol consumption,Ramsay and satisfaction scores were recorded within 24 h postoperatively.The numbers of patients who needed urapidil,ephedrine or atropine,and sides effects,such as vomiting and respiratory depression,were recorded within 24 h postoperatively.Results The consumption of tramadol and VAS scores were significanly lower while Ramsay scores and the satisfaction scores were significanly higher in group Ⅱ and Ⅲ than those in group Ⅰ within 24 h postoperatively(P<0.05).The consumption of tramadol and VAS scores and the numbers of patients who needed urapidil were significantly decreased in group Ⅲ compared with group Ⅱwithin 24 h after operation.Conclusion Small dose of dexmedetomidine combined with tramadol PCIA was safe and effective for elderly patients with essential hypertension,and it can prevent further deterioration of postoperative hypertension.