右美托咪定复合舒芬太尼在下肢骨折患者术后静脉自控镇痛中的应用

目的：评价右美托咪定复合舒芬太尼在下肢骨折患者术后静脉自控镇痛（PCIA）中的应用效果。方法150例择期全麻下行下肢骨折切开复位内固定患者，美国麻醉师协会（ASA）分级为Ⅰ~Ⅱ级，随机均等分为5组：不同剂量舒芬太尼组（S1、S2组），舒芬太尼复合不同剂量右美托咪定组（M1、M2、M3组）。于手术结束即刻行 PCIA，均用生理盐水稀释至100 ml，首次剂量均为舒芬太尼0.1μg/ kg，静脉镇痛泵背景输注速度2 ml/ h，自控给药剂量0.5 ml，锁定时间15 min。分别于术后1（T1）、3（T2）、6（T3）、12（T4）、24（T5）和48 h（T6）各时间点，采用视觉模拟评分法（VAS）评价患者疼痛程度及 Ramsay 镇静评分评价患者镇静程度；记录患者术后48 h 内 PCIA 按压总次数及地佐辛用量；并记录术后48 h内恶心、呕吐、皮肤瘙痒、呼吸抑制和低血压的发生情况。结果与 S1、M1组比较，S2、M2、M3组 T1~ T6 VAS 评分降低（P <0.05），M3组 T1~ T6 Ramsay 评分升高（P <0.05），S2、M2、M3组 PCIA 按压总次数及地佐辛消耗量均减少（ P <0.05）。M2组未出现并发症，S2组较 S1、M1、M2、M3组恶心呕吐、皮肤瘙痒、呼吸抑制发生例数增加（P <0.05）；M2、M3组较 S1组恶心呕吐发生例数减少（P <0.05）；M3组较 M2组呼吸抑制发生例数增加（P <0.05）；M3组较 S1、S2、M1、M2组低血压发生例数增加（P <0.05）。结论2μg/ kg 舒芬太尼联合2μg/ kg 右美托咪定镇痛效果满意，副反应少，是骨科患者术后镇痛的较佳配方。

Effect of sufentanil combined with dexmedetomidine on postoperative patient-controlled intravenous analgesia in patients undergoing lower limb fracture surgery

Objective To investigate the effect of combining dexmedetomidine(Dex)and sufentanil on postopera-tive patient-controlled intravenous analgesia(PCIA)in patients of lower limb fracture. Methods One hundred and fifty patients,ASAⅠ ~ Ⅱ,undergoing lower limb fracture surgery,were randomly divided into five groups:different doses of sufentanil groups(S1,S2 group)and sufentanil combining with different doses of dexmedetomidine groups (M1,M2,M3 group). At the end of the surgery,patients immediately received postoperative PCIA. All drugs were diluted with saline to 100 ml. PCIA was set as follows:background infusion 2 ml/ h;bolus dose 0. 1 μg / kg;PCA dose 0. 5 ml;loekout interva 15 min. The scores of VAS and RSS were recorded at 1,3,6,12,24 and 48 hours after PCIA. The press number,dezocine consuming and the incidence rate of the nausea,vomiting,pruritus,respiratory depression and hypotension were recorded for 48 hours. Results Compared with group S1,M1,the VAS score was significantly decreased at T1 ~ T6 in S2,M2,M3(P < 0. 05). The RSS score was significantly increased at T1~ T6 in M3(P < 0. 05). The press number,and dezocine consuming was significantly decreased at T1 ~ T6 in S2, M2,M3(P < 0. 05). There were no complications in group M2. The occurrence of nausea,vomiting,pruritus,re-spiratory depression was significantly decreased in S1,M1,M2,M3 than S2(P < 0. 05). Compared with S1,the oc-currence of nausea and vomiting was significantly decreased in M2,M3(P < 0. 05). The occurrence of respiratory depression in M3 Group was significantly higher than M2 group(P < 0. 05). The occurrence of hypotension in M3 Group was significantly higher than other groups(P < 0. 05). Conclusion Sufentanil 2 μg / kg plus Dex 2 μg / kg has better satisfactory analgesia effect and less side effect. It is a better compound for orthopaedic.