右美托咪定复合舒芬太尼用于胸腔镜术后静脉镇痛的量效关系

目的 探讨右美托咪定(DEX)复合0.032 μg/(kg·h)舒芬太尼用于胸腔镜手术静脉患者自控镇痛(PCIA)的半数有效剂量(ED₅₀)和95%有效剂量(ED₉₅)及其镇痛效果。方法 选择择期胸腔镜手术患者25例,采用DEX与0.032 μg/(kg·h)舒芬太尼进行术后PCIA,DEX起始剂量为0.048 μg/(kg·h),相邻患者的剂量之差为0.008 μg/(kg·h);当前患者DEX剂量由上一个患者术后镇痛效果是否满意决定,如果上一例患者术后镇痛满意,则当前患者使用DEX剂量降0.008 μg/(kg·h);如果上一例患者术后镇痛不满意,则当前患者使用DEX剂量升0.008 μg/(kg·h);研究终点为7个上下周期,DEX剂量<0.008 μg/(kg·h),并持续7例;用概率单位回归分析法计算DEX的ED₅₀、ED₉₅及其相应的95%CI。结果 DEX复合0.032 μg/(kg·h)舒芬太尼用于青壮年患者胸腔镜术后静脉镇痛DEX 的ED₅₀为0.0346 μg/(kg·h)[95%CI:0.0283~0.0408 μg/(kg·h)],ED₉₅为0.0459 μg/(kg·h)[95%CI:0.0400~0.0880 μg/(kg·h)]。所有患者未出现呕吐、呼吸抑制和心动过缓等不良反应;术后6 h内静息(Z=-5.128,P=0.000)和咳嗽时(Z=-6.642,P=0.000)平均视觉模拟评分和Ramsay镇静评分(Z=-2.335,P=0.020)都明显高于术后6 h。结论 DEX复合0.032 μg/(kg·h)舒芬太尼用于胸腔镜手术患者术后静脉镇痛DEX的ED₅₀和ED₉₅分别为0.0346 μg/(kg·h)和0.0459 μg/(kg·h),术后疼痛可以得到安全有效控制。

Dose-response Relationship of Dexmedetomidine Combined with Sufentail for Postoperative Intravenous Analgesia in Video-assisted Thoracoscopic Surgery

Objective To investigate the 50% effective dose(ED₅₀)and 95% effective dose(ED₉₅)of dexmedetomidine(DEX)combined with 0.032 μg/(kg·h)sufentanil as well as its analgesic effect for patient-controlled intravenous analgesia(PCIA)after video-assisted thoracoscopic surgery(VATS).Methods Totally 25 patients undergoing elective VATS were enrolled. DEX and 0.032 μg/(kg·h)sufentanil were used for postoperative PCIA. The loading dose of DEX was 0.048 μg/(kg·h),and the dose difference between two adjacent patients was 0.008 μg/(kg·h). The DEX dose of a current patient was determined by whether the previous patient was satisfied with postoperative analgesic effect. If the previous patient was satisfied with postoperative analgesic effect,the DEX dose of the current patient was decreased by 0.008 μg/(kg·h);and if the previous analgestic effect was not satisfactory,DEX dose of the current patient was increased by 0.008 μg/(kg·h). The study endpoint was dexmedetomidine dose was<0.008 μg/(kg· h) within 7 upper and lower cycles in 7 consecutive cases. Finally,the probability unit regression was used to estimate the ED₅₀ and ED₉₅ of DEX and their 95% CI.Results When DEX combined with 0.032 μg/(kg·h) sufentanil was used for postoperative PCIA in young patients undergoing VATS,the ED₅₀ and ED₉₅of DEX were 0.0346 μg/(kg· h)[95%CI:0.0283-0.0408 μg/(kg·h)] and 0.0459 μg/(kg·h)[95%CI:0.0400-0.0880 μg/(kg·h)],respectively. No adverse reaction such as vomiting,respiratory depression,or bradycardia occurred. The average Visual Analogue Scale(VAS)scores at rest(Z=-5.128,P=0.000)and cough(Z=-6.642,P=0.000)and the Ramsay sedation score(Z=-2.335,P=0.020)within 6 hours after surgery were higher than those after 6 hour.Conclusion DEX combined with 0.032 μg/(kg·h) sufentanil are effective for postoperative PCIA in patients undergoing VATS when the ED₅₀ and ED₉₅ are 0.0346 μg/(kg·h)and 0.0459 μg/(kg·h),respectively.