摘要
目的探讨不同剂量右美托咪定复合舒芬太尼用于创伤骨科患者术后镇痛、镇静的效果及安全性。方法 ASAⅠ~Ⅱ级行创伤骨科手术患者60例,随机分为3组各20例。舒芬太尼组术后自控镇痛应用舒芬太尼1.0μg/（kg·d）＋阿扎司琼6mg＋生理盐水100mL,低剂量右美托咪定复合舒芬太尼组（低剂量组）应用右美托咪定1.0μg/（kg·d）＋舒芬太尼1.0μg/（kg·d）＋阿扎司琼6mg＋生理盐水100mL,高剂量右美托咪定复合舒芬太尼组（高剂量组）应用右美托咪定1.5μg/（kg·d）＋舒芬太尼1.0μg/（kg·d）＋阿扎司琼6mg＋生理盐水100mL。记录3组术后2h（T1）、4h（T2）、8h（T3）、24h（T4）、48h（T5）VAS、Ramsay评分,比较3组术后48h自控镇痛按压次数及不良反应发生情况。结果 T1、T2、T3、T4、T5时间点,低剂量组VAS评分（1.5±0.8、1.2±0.8、1.1±0.9、1.0±0.9、0.8±0.6）,高剂量组VAS评分（1.3±1.0、1.4±0.9、1.2±0.8、1.0±0.8、0.9±0.8）均低于舒芬太尼组（2.3±0.8、2.2±0.9、1.9±0.9、1.8±0.9、1.6±0.9）（P〈0.05）,低剂量组Ramsay评分（2.9±0.6、2.7±0.7、2.4±0.7、2.2±0.6、2.2±0.5）、高剂量组Ramsay评分（3.0±0.5、3.0±0.6、2.7±0.6、2.6±0.8、2.4±0.6）均高于舒芬太尼组（1.8±0.5、2.0±0.5、1.9±0.5、1.8±0.5、2.0±0.6）（P〈0.05）,低剂量组与高剂量组各时间点VAS评分比较差异无统计学意义（P〉0.05）,高剂量组T4时间点Ramsay评分高于低剂量组（P〈0.05）;舒芬太尼组术后48h自控镇痛按压次数（（68±3）次）高于低剂量组（（25±6）次）和高剂量组（（11±2）次）（P〈0.05）,恶心呕吐发生率（30.0%）高于低剂量组（10.0%）和高剂量组（5.0%）,心动过缓发生率（10.0%）低于低剂量组（30.0%）和高剂量组（30.0%）（P〈0.05）,高剂量组自控镇痛按压次数和恶心呕吐发生率低于低剂量组（P〈0.05）。结论右美托咪定复合舒芬太尼用于创伤骨科患者术后镇痛、镇静效果优于舒芬太尼,并可降低恶心呕吐发生率;应用高剂量右美托咪定自控镇痛次数较少,恶心呕吐发生率低,但可导致过度镇静。
Objective To investigate the safety and effects of analgesia and sedation of different dose of dexmedetomidine combined with sufentanil on postoperative analgesia in patients undergoing traumatic orthopedic surgeries.Methods Sixty patients with ASA physical status Ⅰ to Ⅱ undergoing traumatic orthopedic surgeries were randomly divided into three groups,with 20 patients in each group,sufentanil group receiving sufentanil 1.0μg/（kg·d）＋ azasetron 6mg ＋normal saline 100 mL,low-dose group receiving dexmedetomidine 1.0μg/（kg·d）＋ sufentanil 1.0μg/（kg·d）＋azasetron 6mg ＋ normal saline 100 mL,and high-dose group receiving dexmedetomidine 1.5μg/（kg·d）＋ sufentanil1.0μg/（kg·d）＋ azasetron 6mg＋ normal saline 100 mL.The visual analog scale（VAS）and Ramsay sedation score were recorded at the time points of 2h（T1）,4h（T2）,8h（T3）,24h（T4）and 48h（T5）after operation.The number of patient-controlled press of the pump and the incidence of adverse reactions were compared among three groups.Results VAS scores at the time points of T1,T2,T3,T4 and T5 were significantly lower in low-dose group（1.5±0.8,1.2±0.8,1.1±0.9,1.0±0.9,0.8±0.6）and in high-dose group（1.3±1.0,1.4±0.9,1.2±0.8,1.0±0.8,0.9±0.8）than those in sufentanil group（2.3±0.8,2.2±0.9,1.9±0.9,1.8±0.9,1.6±0.9）（P〈0.05）.The Ramsay scores at the time points of T1,T2,T3,T4 and T5 were significantly higher in low-dose group（2.9±0.6,2.7±0.7,2.4±0.7,2.2±0.6,2.2±0.5）and high-dose group（3.0±0.5,3.0±0.6,2.7±0.6,2.6±0.8,2.4±0.6）than those in sufentanil group（1.8±0.5,2.0±0.5,1.9±0.5,1.8±0.5,2.0±0.6）（P〈0.05）.There were no significant differences in the VAS scores at all the time points between low-dose group and high-dose group（P〉0.05）.But the Ramsay score at T4 was higher in high-dose group than that in low-dose group（P〈0.05）.The patient-controlled press times of the pump was more,the incidence of nausea and vomiting was higher,and the incidence of bradycardia was lower in sufentanil group（68±3,30.0%,10.0%）than those in low-dose group（25±6,10.0%,30.0%）and high-dose group（11±2,5.0%,30.0%）（P〈0.05）.The patient-controlled press times of the pump was less,and the incidence of nausea and vomiting was lower in high-dose group than that in low-dose group（P〈0.05）. Conclusion Dexmedetomidine combined with sufentanil has better analgesic and sedate effect than sufentanil in patients undergoing traumatic orthopedic surgeries,and can decrease the incidence of nausea and vomiting.The high-dose dexmedetomidine has less patient-controlled press times of the pump,and lower incidence of nausea and vomiting,but it could result in over sedation.
出处
《中华实用诊断与治疗杂志》
2015年第2期196-198,共3页
Journal of Chinese Practical Diagnosis and Therapy
关键词
创伤骨科手术
术后镇痛
右美托咪定
Traumatic orthopedic surgeries
postoperative analgesia
dexmedetomidine
作者简介
通信作者：魏华，E-mail：weihuazzu@163．com。
