右美托咪啶对开胸手术术后芬太尼自控静脉镇痛效果的影响

目的:探讨右美托咪啶对开胸手术患者术后芬太尼自控静脉镇痛效果的影响。方法:ASAⅠ~Ⅲ级择期行开胸手术患者40例,随机分成2组,术后均行静脉自控镇痛(PCIA),镇痛药配方为芬太尼20 μg/kg(C组),芬太尼20 μg/kg+右美托咪啶10 μg/kg(D组),用0.9%氯化钠注射液稀释至100 ml。初始负荷剂量2 ml,持续剂量2 ml/h,单次静脉快注(Bolus)剂量0.5 ml,锁定时间15 min。记录各组患者术后24 h内Bolus总按压次数及芬太尼用量,术后4、8、24、48 h的镇痛视觉模拟评分和Ramsay镇静评分,术后各组患者呼吸抑制、恶心呕吐、心率<50次/分,收缩压<90 mmHg等不良反应的发生情况,于麻醉前、术后4、8、24 h测定血清皮质醇浓度;于术后48 h评价患者满意度。结果:与C组比较,D组术后24 h内Bolus总按压次数减少,芬太尼用量降低(P<0.01);D组各时点Ramsay镇静评分均较C组明显升高(P<0.01),D组术后4 h和8 h的镇痛视觉模拟评分均较C组降低(P<0.01和P<0.05);2组患者呼吸抑制、恶心呕吐发生率及术后4～48 h皮质醇水平差异均无统计学意义(P>0.05),D组患者满意度高于C组(P<0.05)。结论:右美托咪啶复合芬太尼用于开胸手术后PCIA的效果优于单独应用芬太尼。

Role of dexmedetomidines in patient-controlled intravenous analgesia with fentanil after thoracic surgery

Objective: To investigate the influence of dexmedetomidine on patient-controlled intravenous analgesia(PCIA)with fentanil after thoracic surgery.Methods: Forty ASAⅠ-Ⅲ patients scheduled for elective thoracic surgery were randomly divided into two groups(n=20,each)according to the PCIA formula.Group C received fentanil 20 μg/kg and group D fentanil 20 μg/kg plus dexmedetomidine 10 μg/kg;and the PCIA was diluted with 100 saline.The initial loading volume was 2 ml,background volume 2 ml/h and bolus dose 0.5 ml;the lockout time was set to 15 min.The number of the pressing attempts,consumption of fentanil within 24 h,the visual analogue scales,and the Ramsay sedation scale at 4,8,24 and 48 h after surgery were recorded;the incidence of vomiting and respiration depression was also recorded.Blood samples were obtained before anesthesia,4,8 and 24 h after surgery for determination of serum cortisol concentration.The patients' satisfactory degree was evaluated 48 h after surgery.Results: Compared to group C,group D had a decreased number of PCIA pressing attempts and consumption of fentanil within 24 h after operation(P<0.01);the Ramsay sedation scale of group D increased at 4,8,24 and 48 h after surgery;the visual analogue scales of group D decreased at 4 and 8 hour after surgery(P<0.01 to P<0.05).The incidence of respiratory inhibition vomiting and serum cortisol concentration after operation had no significant differences between the two groups(P>0.05).The satisfaction degree of the patients in group D was significantly higher than that in group C(P<0.05).Conclusions: The effect of combination use of dexmedetomidine and fentanil is superior to fentanil alone in PCIA after thoracic surgery.