舒芬太尼复合右旋美托咪定用于膝关节置换术后患者镇痛的效果观察

目的观察舒芬太尼复合右美托咪定用于膝关节置换术后患者镇痛的临床效果。方法选择ASAⅠ或Ⅱ级择期行膝关节置换手术患者60例,随机分为三组,每组20例。Ⅰ组术后镇痛给予舒芬太尼125μg/（kg.d）,Ⅱ组给予舒芬太尼110μg/（kg.d）,Ⅲ组给予舒芬太尼110μg/（kg.d）＋右美托咪定110μg/（kg.d）。三组术后镇痛持续剂量2 mL/h,单次负荷剂量0.2 mL,锁定时间30 min,总容量100 mL。记录三组术毕（T0）及术后4 h（T1）、8 h（T2）、12 h（T3）、24 h（T4）和48 h（T5）疼痛视觉模拟评分（VAS）、Ramesay镇静评分及不良反应发生率。结果三组术后各时点疼痛VAS评分均〈4分,T1～5时Ⅱ组疼痛VAS评分显著高于Ⅰ、Ⅲ组（P〈0.05）;0～24 h内Ⅱ组自控按压次数明显多于Ⅰ组和Ⅲ组（P〈0.05）。Ⅰ、Ⅱ组术后T1～4Ramesay评分明显低于Ⅲ组（P〈0.05）,其他时段差异无统计学意义（P〉0.05）。Ⅰ组恶心呕吐发生率高于Ⅱ、Ⅲ组（P〈0.05）。结论右美托咪定用于膝关节置换术后镇痛可减少舒芬太尼使用量,同时降低其恶心呕吐发生率,但心动过缓发生率增高。

Observation of effect on Sufentanil combined with Dexmedetomidine on postoperative analgesia in patients undergoing knee joint replacement surgeries

Objective To observe the clinical effect of Sufentanil combined with Dexmedetomidine on postoperative analgesia in patients undergoing knee joint replacement surgeries.Methods 60 patients with ASA physical Ⅰ or Ⅱ undergoing elective knee joint replacement surgeries were randomly divided into three groups,with 20 cases in each group.Group Ⅰ received Sufentanil 125 μg/（kg·d）,group Ⅱ received Sufentanil 110 μg/（kg·d）,group Ⅲ received Sufentanil 110 μg/（kg·d） ＋ Dexmedetomidine 110 μg/（kg·d）.The analgesic pump was set in the three group as follows： continuous perfusion rate 2 mL/h,single bolus 2 mL,lockout time 30 min,total volume 100 mL.Pain intensith was assessed with visual analog scale（VAS） at the immediate time after operation（T0） and 4 h（T1）,8 h（T2）,12 h（T3）,24 h（T4） and 48 h（T5） after operation.The Ramesay evaluation and the incidence of side effects were recorded.Results VAS scorings of the three groups at all the time points were less than 4 points,but group Ⅱ at T1-5 displayed higher pain intensity than that of the group Ⅰ and group Ⅲ（P〈0.05）.And the number of self-controlled press of the pump in group Ⅱ was lower markedly more than group Ⅰ and group Ⅲ at 0-24 h（P〈0.05）.Ramesay scores of group Ⅰ and Ⅱ were lower than group Ⅲ at T1-4 after operation（P〈0.05）,there were no differences at other time（P〈0.05）.The incidence of nausea and vomiting in group Ⅰ was higher than groups Ⅱ and Ⅲ（P〈0.05）.Conclusion Dexmedetomidine can reduce postoperative consumption of Sufentanil in patients undergoing knee joint replacement surgeries,and decrease the incidence of nausea and vomiting.