不同剂量右美托咪定复合舒芬太尼静脉自控镇痛对肺癌根治术后镇痛效果的比较

目的:比较不同剂量右美托咪定复合舒芬太尼静脉自控镇痛(PCIA)对肺癌根治术后的镇痛效果。方法:选择80例择期行肺癌根治术患者，年龄43~65岁，ASA Ⅰ或Ⅱ级。按随机数字表分为4组（n=20）:S组（舒芬太尼3 μg/kg+氟比洛芬酯100 mg）、D1组［舒芬太尼3 μg/kg+右美托咪定0.1 μg/(kg·h)］、D2组［舒芬太尼3 μg/kg+右美托咪定0.15 μg/(kg·h)］、D3组［舒芬太尼3 μg/kg+右美托咪定0.2 μg/(kg·h)］。患者行静吸复合麻醉，于手术结束前30 min连接静脉镇痛泵。镇痛泵药液按上述四组药物配制，容量100 ml。输注设置:输注速率1.5 ml/h，单次按压给药量2 ml，锁定时间15 min，维持时间48 h。分别记录术后2、4、12、24、48 h的VAS疼痛评分、Ramsay镇静评分、平均动脉压（MBP）、心率（HR）、PCIA按压次数、不良反应情况。结果:四组患者在2~48 h各时点VAS评分比较差异无统计学意义；在2~48 h期间，D2和D3组Ramsay镇静评分明显高于S组（P＜0.05），D2和D3组MBP明显低于S组（P<0.05），D3组HR明显低于S组（P<0.05）；与S组比较，D2和D3组恶心呕吐发生率较低（P＜0.05），D1组PCIA按压次数较多（P＜0.05），D3组过度镇静和心动过缓发生率较高（P＜0.05）。结论:右美托咪定［0.15 μg/(kg·h)］复合舒芬太尼（3 μg/kg）用于肺癌根治术能够获得完善镇痛效果，恶心呕吐发生率较低，血流动力学更稳定，未见显著心动过缓和过度镇静。

Comparison of different dose of dexmedetomidine combined with sufentanil for PCIA on postoperative analgesia in patients undergoing lung cancer surgery

Objective:To observe the analgesia effects of different dose of dexmedetomidine combined with sufentanil for PCIA in patients undergoing lung cancer surgery.Methods:Eighty patients(ASA grade Ⅰ or Ⅱ degree，aged 43~65)undergoing lung cancer surgery were randomly assigned into four groups according to PCIA formulation(n=20).Group S:Sufentanil 3 μg/kg+flubiprofen 100 mg.Group D1:Dexmedetomidine 0.1 μg/(kg·h)+sufentanil 3 μg/kg.Group D2:Dexmedetomidine 0.15 μg/(kg·h)+sufentanil 3 μg/kg.Group D3:Dexmedetomidine 0.2 μg/(kg·h)+sufentanil 3 μg/kg.All patients received the same anesthesia method.Patients-controlled intravenous analgesia pump was applied 30 min before the end of surgery.The drugs were diluted to 100 ml with 0.9% normal saline.Settings:Infusion speed 1.5 ml/h.PCIA dosage 2 ml each time，lock time 15 min.VAS score，Ramsay score，MBP，HR，pressing times，side effects at 2，4，12，24，48 h after surgery were recorded.Results:There were no significant difference in VAS score at 2~48 h between four groups.The Ramsay score of group D2 and D3 was higher than group S at 2~48 h(P＜0.05).The MBP of group D2 and D3 was lower than group S at 2~48 h(P＜0.05).The HR of group D3 was lower than group S at 2~48 h(P＜0.05).Compared with group S，the incidence of postoperative nausea and vomiting was lower in group D2 and D3(P＜0.05).PCIA pressing times was more in group D1(P＜0.05)，and the incidence rate of hypersomnia and bradyrhythmia was higher in group D3.Conclusion:Dexmedetomidine［0.15 μg/(kg·h)］combined with sufentanil(3 μg/kg)for PCIA after lung cancer surgery acquired satisfied analgesic effect，decreased the rate of vomiting and nausea without more hypersomnia and bradyrhythmia，and provided more stable hemodynamics.