右美托咪定与布托啡诺用于老年全髋关节置换术后自控镇痛效果的比较  

Comparison of Dexmedetomidine and Bhutto Butorphanol for Analgesia Effect after Total Hip Replacement in the Elderly

作　　者：杨帅[1] 华丽[1] 王雄[1] 王两忠[1] 陈勇[1] Yang Shuai Hua Li Wang Xiong et al(Department of Anesthesia,Affiliated Hospital of Chengdu University, Chengdu, Si- chuan 610081, China)

机构地区：[1]成都大学附属医院麻醉科,四川成都610081

出　　处：《四川医学》2017年第1期36-39,共4页Sichuan Medical Journal

摘　　要：目的对右美托咪定和布托啡诺用于老年患者全髋关节置换术后自控镇痛的安全性和有效性进行比较。方法选择我院2015年2月至2016年3月期间择期行全髋关节置换术的患者60例,患者自愿要求实施术后镇痛,患者年龄65~85岁,美国麻醉医师协会分级Ⅰ~Ⅱ级,随机分为两组(D组和B组),每组30例。D组患者术后镇痛采用右美托咪定1.5μg/kg+舒芬太尼1μg/kg+昂丹司琼0.3mg/kg加生理盐水至200m L;B组患者术后镇痛采用布托啡诺0.2mg/kg+舒芬太尼1μg/kg+昂丹司琼0.3kg/kg加生理盐水至200m L。观察两组患者术前和术后2h,4h,8h,12h,48h时无创血压情况、心率、视觉模拟评分(VAS评分)、Ramsay评分、布氏舒适评分(BCS)、PCIA有效按压次数、不良反应发生情况。结果 D组血流动力学较B组更为平稳,差异有统计学意义(P<0.05),D组各时间点VAS评分和BCS评分与B组比较无统计学意义(P>0.05),D组Ramsay评分优于B组,差异有统计学意义(P<0.05);两组患者术后48h PCIA按压次数差异有统计学意义(P<0.05);D组不良反应发生情况少于B组,差异有统计学意义(P<0.05)。结论右美托咪定用于老年患者全款置换术后镇痛的有效性优于布托啡诺,但不良反应尚需进一步研究。Objective To compare the efficacy and safety of dexmedetomidine and butorphanol used in patient-controlled analgesia in elderly patients after total hip arthroplasty. Methods The study involved 60 cases undergoing total hip arthroplasty in our hospital from February 2015 to March 2016. These patients from 65 to 85 years of age, graded I-II by American Society of Anes- thesiologists volunteered to implement postoperative analgesia and were randomly divided into two groups（ Group D and Group B）, 30 cases in each group. About postoperative analgesia,patients of Group D were used dexmedetomidine 1.5 g/kg ＋ sufentanil 1 g/ kg ＋ ondansetron 0. 3mg/kg plus normal saline to 20OmL while Group B were used butorphanol 0. 2mg/kg ＋ sufentanil lg/kg ＋ ondansetron 0. 3kg/kg plus normal saline to 200mL. Then we observed non-invasive blood pressure, heart rate, visual analogue score （VAS score）, Ramsay score, Brandt comfort score （BCS）, PCIA press times and adverse effects of two groups of patients be- fore and after 2h,4h,8h, 12h,48h of the operations. Results The hemodynamics of Group D was more stable than that of Group B and the difference was statistically significant（P 〈0. 05）. The differences of VAS scores and BCS scores between two groups were not statistically significant（ P 〉 0. 05 ）. The Ramsay score was better than that of B group and the difference was statistically significant（P 〈 0. 05 ）. There was a statistically significant difference in the 45h PCIA pressing times between two groups （P 〈 0. 05 ）. Less adverse effects were occurred in Group D compared to Group B and the difference was statistically significant （ P 〈 0.05 ）. Conclusion The efficacy of dexmedetomidine used in postoperative analgesia in elderly patients after total hip arthroplasty is bet- ter than Bhutto butorphanol, but its adverse effects still need further study.

关 键 词：右美托咪定 布托啡诺 全髋置换术 自控镇痛 

分 类 号：R614[医药卫生—麻醉学]