右美托咪定复合不同剂量舒芬太尼对脊柱手术患者术后镇痛的影响

目的观察右美托咪定复合不同剂量舒芬太尼对脊柱手术患者术后镇痛的影响。方法择期行脊柱手术患者60例,年龄18~70岁,ASAⅠ或Ⅱ级。随机均分为三组,术后镇痛分别给予舒芬太尼3μg/kg(S1组)、右美托咪定1.5μg/kg+舒芬太尼2μg/kg组(S2组)和右美托咪定1.5μg/kg+舒芬太尼1μg/kg组(S3组)。三组麻醉诱导:静注咪达唑仑0.05 mg/kg、依托咪酯0.3mg/kg、舒芬太尼0.8μg/kg,于手术结束前30 min连接静脉镇痛泵行患者自控静脉镇痛(patientcontrolled intravenous analgesia,PCIA),背景输注流速3 ml/h,单次追加药量0.5 ml,锁定时间15min,总容量150ml。分别记录三组患者术后2h(T0)、4h(T1)、8h(T2)、12h(T3)、24h(T4)、48h(T5)的VAS疼痛评分、Ramsay镇静评分和术后不良反应的情况。结果 T1~T5时S2组和S3组VAS评分均明显低于S1组(P0.05);三组Ramsay镇静评分、恶心、呕吐、嗜睡、心动过缓等不良反应发生率差异无统计学意义。结论复合1.5μg/kg右美托咪定用于脊柱骨科手术术后镇痛可显著减少舒芬太尼的用量,同时降低其恶心呕吐等不良反应的发生率且无心动过缓和嗜睡发生。

Effect of dexmedetomidine combined with different-doses of sufentanil on postoperative analgesia in pa-tients undergoing spine surgery

Objective To observe the analgesic effects of dexmedetomidine combined with dif-ferent-doses of sufentanil in patients undergoing spine surgery.Methods Sixty patients(ASA grade Ⅰor Ⅱ degree,age 18-70 years)undergoing spine surgery were randomly assigned into three groups ac-cording to PCA formulation(n =20):3 μg/kg sufentanil group (group S1),1.5 μg/kg dexmedetomi-dine+ 2 μg/kg sufentanil group (group S2 )and 1.5 μg/kg dexmedetomidine + 1 μg/kg sufentanil group (group S3).The same anesthesia method was applied among three groups.Patient-controlled intravenous analgesia pump was applied before 30 minutes prior to the end of surgery.The drugs in each group were diluted to 1 50 ml and infused by a pump at a rate of 3 ml/h with a patient-controlled analgesia (PCA)bolus of 0.5 ml and lock time of 30 minutes.VAS and Ramsay scores at 2 h(T0 ),4 h (T1 ),8 h(T2 ),12 h(T3 ),24 h(T4 )and 48 h(T5 )after surgery were estimated.Postoperative nausea and vomiting,bradyrhythmia and hypersomnia were also recorded.Results Compared with group S1, VAS of groups S2 and S3 was significantly decreased at T1-T5 (P <0.05).There were also no signifi-cant difference in the incidence of postoperative nausea and vomiting,bradyrhythmia and hypersomnia among three groups.Conclusion Dexmedetomidine of 1.5 μg/kg can significantly reduce the dosage of sufentanil on postoperative analgesia in patients undergoing spine surgery,and decrease the rate of postoperative nausea and vomiting without any bradyrhythmia and hypersomnia.