右美托咪定和地左辛联合术后自控静脉镇痛研究

目的评估不同剂量右美托咪定联合地佐辛术后患者静脉自控镇痛（PCIA）的有效性和安全性。方法 240例行择期手术,ASAⅠ-Ⅲ级,18-65岁的患者,随机分为4组：舒芬太尼组（S组）、低剂量右美托咪定＋地佐辛组（DD1组）、中剂量右美托咪定＋地佐辛组（DD2组）、高剂量右美托咪定＋地佐辛组（DD3组）,每组各60例。S组镇痛泵为舒芬太尼1.5μg/kg＋昂丹司琼8mg＋0.9%氯化钠注射液。其它3组为右美托咪定＋地左辛1mg/kg＋昂丹司琼8mg＋0.9%氯化钠注射液,DD1组、DD2组和DD3组右美托咪定剂量分别为2.5μg/kg、5μg/kg和7.5μg/kg。镇痛泵容量100ml,持续输注量2ml/h,PCA量0.5ml,锁定时间15min。采用VAS评分和Ramsy镇静评级评估术后2h、4h、8h、12h、24h和48h的疼痛程度和镇静情况,同时记录不良反应发生情况,并于术后4h、12h、24h、48h时测定血浆皮质醇浓度。结果 VAS评分,S组、DD2组、DD3组3组间比较差异无统计学意义（P〉0.05）,DD1组显著高于其它3组（P〈0.05）。DD3组和DD2组Ramsy镇静显著高于S组和DD1组（P〈0.05）,DD3组Ramsy镇静显著高于DD2组（P〈0.05）。DD1组和DD2组的不良反应发生率显著低于S组和DD3组（P〈0.05）。结论中剂量5μg/kg右美托咪定联合地左辛PCIA,镇痛效果满意,不良反应少,是一种安全有效的镇痛方案。

Effect of Dexmedetomidine and Dezocine used in combination for postoperative patient-controlled intravenous analgesia

Objective To evaluate the efficacy and safety of various dosage dexmedetomidine combined dezocine, used for postoperative patient-controlled intravenous analgesia（PCIA）in patients. Methods Two hundred and forty ASA I ~ ]II , 18~65 years old patients undergoing elective surgery, were randomly dinided into 4 groups： Sufentanil group（group S）, low dose Dexmedetomidine＋Dezocine group （group DD1）, mediun dose Dexmedetomidine＋Dezocine group （group DD2）, high dose Dexmedetomidine ＋Dezocine group （group DD3）. For postoperative PCIA , the patients in group S received a protocol of Sufentanil 1.5 ~tg/kg ~- Ondansetron 8mg＋ 0.9%NaCI solution in pump, those in other 3 groups received Dexmedetomidine ＋Dezocine lmg/kg ＋ Ondansetron 8mg＋ 0.9% NaC1 solution in pump, the doses of dexmedetomidine in Group DD1, Group DD2 and Group DD3 were 2.5 Ixg/kg, 5 p.g/kg and 7.5 Ixg/kg. All the anesthetic agents were diluted to 100 ml and infused by a pump at the background dose rate of 2 ml/h with a patient-controlled bolus of 0.5 ml and the lock out time of 15 min. The VAS and Ramsay scores were used to evaluate the analgesic effect at 2 h, 4 h, 8 h, 12 h, 24 h and 48 h after surgery, plasma cortisol were detected at 4 h, 12 h, 24 h and 48 h after surgery, and the adverse effects associated with PCIA were recorded. Results The VAS scores did not indicate a significant difference in Group S, Group DD1 and Group DD3 （P〉 0.05）, and the VAS scores of Group DD1 were higher than other groups significantly （P〈0.05）. The Ramsay score of Group DD3 and Group DD 3 were higher than Group S and Group DD1 significantly （P〈O.05）, the Ramsay score of Group DD3 was higher than Group DD2 significantly （P〈O.05）. The incidence of adverse effect of Group DD1 and Group DD2 were lower significantly than Group S and Group DD3 （P〈O.05）. Conclusion PCIA with a combination of medium dose Dexmedetomidine 5 ~tg/kg and dezocine produces satisfactory analgesic effect, and can significantly reduce adverse effects.