不同剂量右美托咪定对全麻骨科手术术后静脉自控镇痛的影响研究  

Effect of different dosages of dexmedetomidine on postoperative patient-controlled intravenous analgesia(PCIA)in orthopedic surgery under general anesthesia

作　　者：陈爱芳 项余华 罗苹 叶月利 留成胜 CHEN Ai-fang;XIANG Yu-hua;LUO Ping;YE Yue-li;LIU Cheng-sheng(Department of Anesthesiology,Quzhou Hospital of Traditional Chinese Medicine,Quzhou 324000,China;Department of Orthopedics,Quzhou Hospital of Traditional Chinese Medicine,Quzhou 324000,China)

机构地区：[1]衢州市中医医院麻醉科,浙江衢州324000 [2]衢州市中医医院骨科,浙江衢州324000

出　　处：《实用药物与临床》2020年第6期539-542,共4页Practical Pharmacy and Clinical Remedies

基　　金：2018年浙江省医学会临床科研基金项目(2018ZYC-A138)。

摘　　要：目的探究不同剂量右美托咪定(Dex)应用于全麻骨科手术中对术后病人静脉自控镇痛(PCIA)的影响。方法选取我院2017年7月至2019年7月收治的ASAⅠ~Ⅱ级的全麻骨科手术患者168例,按照随机数字表法分为低剂量组、中剂量组、高剂量组,每组56例。全部患者均给予5 mg盐酸格拉司琼注射液+200 ml生理盐水,入静脉自控镇痛泵,在此基础上,给予枸橼酸舒芬太尼注射液0.04μg/(kg·h),低、中、高剂量组分别应用1、2、3μg/kg右美托咪定。对比三组患者术后2 h (T0)、12 h (T1)、24 h (T2)、48 h (T3)的VAS评分、Ramsay镇静评分以及并发症发生率。结果 T1、T2时患者VAS评分低于T0时,T3时VAS评分高于T0时,差异均有统计学意义(P<0.05)。T1~T3时,低剂量组VAS评分高于中、高剂量组(P<0.05)。T1~T2时,中剂量组VAS评分低于高剂量组(P<0.05);T3时,中剂量组、高剂量组VAS评分比较差异无统计学意义(P>0.05)。T0、T1时,中剂量组、高剂量组的Ramsay镇静评分高于低剂量组(P<0.05),而中剂量组、高剂量组比较差异无统计学意义(P>0.05)。T2、T3时,低、中、高剂量组的Ramsay镇静评分比较差异无统计学意义(P>0.05)。低剂量组、中剂量组的并发症发生率低于高剂量组(P<0.05),低剂量组与中剂量组的并发症发生率比较差异无统计学意义(P>0.05)。结论 2μg/kg右美托咪定应用于全麻骨科手术的镇痛效果较好,同时降低了并发症发生率。Objective To investigate the effect of different dosages of dexmedetomidine(Dex)on postopera-tive patient-controlled intravenous analgesia(PCIA)in orthopedic surgery under general anesthesia.Methods Totally 168 patients with orthopedic surgery under general anesthesia and ASAⅠ~Ⅱwho were admitted to our hospital from July 2017 to July 2019 were enrolled,and they were divided into low-dose group,medium-dose group,and high-dose group according to the random number table method,56 cases in each group.All the patients were given 5 mg of granis-etron hydrochloride+200 ml of normal saline,which was put into PCIA pump,and they were given citrate fentanyl in-jection 0.04μg/(kg·h);patients in low-dose group,medium-dose group and high-dose group were given different dosages(1,2 and 3μg/kg)of Dex.The VAS score and Ramsay sedation score at 2 h(T 0),12 h(T 1),24 h(T 2)and 48 h(T 3)after operation and the rate of complication were compared among the three groups.Results The VAS score of all the patients at T 1 and T 2 was lower than that at T 0(P<0.05),while the VAS score at T 3 was higher than that at T 0(P<0.05);the VAS score in low-dose group was higher than that in median-dose group and high-dose group at T 1~T 3(P<0.05);the VAS score in medium-dose group was lower than that in high-dose group at T 1~T 2(P<0.05);there was no significant difference in the VAS score between medium-dose group and high-dose group at T 3(P>0.05).The Ramsay sedation score in medium-dose group and high-dose group was higher than that in low-dose group at T 0 and T 1(P<0.05),while no significant difference was found between medium-dose group and high-dose group(P>0.05).There was no significant difference in the Ramsay sedation score among the 3 groups at T 2 and T 3(P>0.05).The rate of complications in low-dose group and medium-dose group was lower than that in high-dose group(P<0.05),while no significant difference was found between low-dose group and medium-dose group(P>0.05).Conclusion Dexmedetomidine 2μg/kg achieves high analgesic effec

关 键 词：右美托咪定 全身麻醉 骨科手术 病人静脉自控镇痛 

分 类 号：R614[医药卫生—麻醉学]