右美托咪定混合舒芬太尼自控静脉镇痛对脊柱手术后患者睡眠质量的影响  

Effect of patient-controlled intravenous analgesia with dexmedetomidine mixed with sufentanil on sleep quality after spinal surgery

作　　者：王昆[1] 李成文[1] 卫宏图[2] 

机构地区：[1]济宁市第一人民医院麻醉科,272011 [2]济宁市第一人民医院骨科,272011

出　　处：《中华麻醉学杂志》2015年第10期1224-1227,共4页Chinese Journal of Anesthesiology

基　　金：山东省自然科学基金（ZR2010HQ007）

摘　　要：目的 探讨右美托咪定混合舒芬太尼自控静脉镇痛对脊柱手术后患者睡眠质量的影响.方法 选择全麻下脊柱手术患者80例,年龄21～72岁,体重48～ 100 kg,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组（n=40）：舒芬太尼组（S组）和右美托咪定混合舒芬太尼组（DS组）.S组镇痛泵用药：舒芬太尼2 μg/kg＋托烷司琼6 mg加生理盐水稀释至100 ml.DS组镇痛泵用药：舒芬太尼2 μg/kg＋右美托咪定3 μg/kg＋托烷司琼6 mg加生理盐水稀释至100 ml.镇痛泵参数设置：背景输注速率2 ml/h,PCA剂量0.5 ml,锁定时间15 min.采用静脉注射舒芬太尼5μg和口服塞来昔布200 mg进行补救镇痛,维持术后48 h内静态数学评分≤4分.于术后1、2、6、12、24、48 h时记录Ramsay镇静评分.采用医学结局研究睡眠量表（MOS-SS）记录术前1周和术后1周平均每日睡眠时间和睡眠障碍指数（SPI）,于术日晚和术后第1天评价睡眠满意度.记录补救镇痛情况.结果 S组和DS组补救镇痛率比较差异无统计学意义（P＞0.05）.与术前比较,S组术后1周平均每日睡眠时间缩短,SPI增加（P＜0.05或0.01）,DS组差异无统计学意义（P＞0.05）.与S组比较,DS组术后1、2、6h时Ramsay评分升高,术后1周平均每日睡眠时间延长,SPI降低,术后第1天睡眠满意度提高（P＜0.05或0.01）.结论 右美托咪定混合舒芬太尼自控静脉镇痛有助于改善脊柱手术后患者的睡眠质量.Objective To investigate the effect of patient-controlled intravenous analgesia （PCIA） with dexmedetomidine mixed with sufentanil on the sleep quality after spinal surgery.Methods Eighty patients of both sexes, aged 21-72 yr, weighing 48-100 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective spinal surgery, were randomly assigned into sufentanil group （group S） and dexmedetomidine mixed with sufentanil group （group DS） with 40 cases in each group.In group S, PCIA solution contained sufentanil 2 μg/kg and tropisetron 6 mg in 100 ml of normal saline.In group DS, PCIA solution contained sufentanil 2 μg/kg, dexmedetomidine 3 μg/kg and tropisetron 6 mg in 100 ml of normal saline.The PCA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h.Sufentanil 5 μg injected intravenously and celecoxib 200 mg given orally were used as rescue analgesics, and numeric rating scale （NRS） score at rest was maintained ≤4 within 48 h after surgery.Ramsay sedation scores were recorded at 1, 2, 6, 12, 24 and 48 h after surgery.Sleep quality was evaluated using the Medical Outcomes Study Sleep Scale （MOS-SS）, and the average time of daily sleep and Sleep Problems Index （SPI） were recorded at week 1 before and after surgery.Patient＇s satisfaction with sleep was assessed on the night of surgery and 1st day after surgery.The requirement for rescue analgesics was recorded.Results There was no significant difference in the requirement for rescue analgesics between group S and group DS （P〉0.05）.Compared with the value before surgery, the average time of daily sleep was significantly shortened, and SPI was increased at week 1 after surgery in group S （P〈0.05 or 0.01）, and no significant change was found in group DS （P〉0.05）.Compared with group S, the Ramsay sedation scores were significantly increased at 1, 2, and 6 h after surgery, the average time of daily sleep was prolonged at week 1 after

关 键 词：右美托咪啶 舒芬太尼 镇痛 病人控制 睡眠 

分 类 号：R614[医药卫生—麻醉学]