右美托咪定对舒芬太尼术后患者自控静脉镇痛消耗量的影响  

The efffect of dexmedetomidine on postoperative sufentanil consumption in patient-controlled intravenous analgesia

作　　者：廖玉巍[1] 吴兴茂[2] 

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110004 [2]中国医科大学附属盛京医院重症监护病房,沈阳110004

出　　处：《中国医师进修杂志》2012年第33期18-20,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨右美托咪定对舒芬太尼术后患者自控静脉镇痛（PCIA）消耗量的影响。方法择期全身麻醉下经腹行全子宫切除术患者80例，ASA分级Ⅰ或Ⅱ级，按随机数字表法分为两组，每组40例，试验组在手术结束前1h缓慢泵人（10rain）右美托咪定0．6μg，kg，对照组给予相同体积0．9％氯化钠，连接舒芬太尼PCIA泵，舒芬太尼2μg／kg＋托烷司琼5mg溶于0．9％氯化钠100ml中，负荷剂量4ml，背景剂量1ml／h，自控剂量1ml／h，锁定时间10min。记录PCIA后1、2,6、12、24h的VAS评分、Ramsay镇静评分（RSS）和舒芬太尼累积消耗量；记录术后24h内恶心、呕吐和寒战等发生情况。结果PICA后各时点两组VAS评分和RSS比较差异无统计学意义（P〉0．05）。试验组舒芬太尼累积消耗量PCIA后1、2,6、12、24h分别为（4．5±0．6）、（7．4±1．2）、（14．2±2．2）、（25．4±3．1）、（40．1±5．3）μg，明显少于对照组的（8．9±0．9）、（13．8±2．9）、（27．2±4．1）、（40．2±5．2）、（62．3±7．1）μg，差异有统计学意义（P〈0．05）。试验组术后24h内恶心、呕吐和寒战的发生率分别为7．5％（3／40）、2．5％（1／40）、2．5％（1／40），明显低于对照组的15．0％（6／40）、7．5％（3／40）、10．0％（4／40），差异有统计学意义（P〈0．05）。结论手术结束前1h缓慢泵人右美托咪定0．6μg／kg可减少术后舒芬太尼消耗量，并降低术后恶心、呕吐和寒战等不良反应。Objective To investigate the effect of dexmedetomidine （Dex） on postoperative sufentanil consumption in patient-controlled intravenous analgesia （PCIA）. Methods Eighty patients（ASA I or ]I ） undergoing abdominal hysterectomy and general anesthesia were divided into 2 groups with 40 cases each by random digits table. Patients in experiment group were received Dex 0.6 μg/kg （in 10 minutes）. Patients in control group were recieved normal saline respectively by pumped infusion one hour before the operation finishing. All patients received a standadized sufentanit PCIA one hour before the operation finishing, sufentanil 2 μg/kg in 100 ml saline with tropisetron 5 mg,the loading dose was 4 ml,the backgroud dose was 1 ml/h, the controlled dose was 1 ml/h, the lock time was 10 minutes. The scores of VAS and RSS were recorded 1,2,6,12 and 24 hours after PCIA,and the incidence rate of the nausea, vomiting and shivering were recorded too for 24 hours. Results There was no statistical significance between the two groups in the scores of VAS and RSS after PCIA. The sufentanil consumption 1,2,6,12 and 24 hours after PCIA in experiment group [ （4.5 ± 0.6 ）, （7.4 ± 1.2 ）, （ 14.2 ± 2.2 ）, （25.4 ± 3.1 ）, （40.1 ± 5.3 ） μg ] was less than that in control group [ （8.9 ± 0.9）, （ 13.8 ± 2.9）, （27.2 ± 4.1 ）, （40.2 ± 5.2）, （62.3 ± 7.1 ） μg] （P 〈 0.05 ）. The incidence of postoperative nausea, vomiting and shivering in experiment group [ 7.5% （3/40）,2.5%（1/40） ,2.5%（ 1/40）] was less than that in control group 115.0%（6/40）,7.5%（3/40）, 10.0%（4/40）] （P 〈 0.05 ）. Conclusion The patients receive Dex 0.6 μg/kg one hour before the operation finishing, need less consumption of sufentanil and occur less postoperative nausea, vomiting and shivering.

关 键 词：右美托咪啶 舒芬太尼 镇痛 病人控制 消耗量 

分 类 号：R614[医药卫生—麻醉学]