不同剂量舒芬太尼联合右美托咪定PCIA对骨折术后患者的镇痛效果  

Analgesic effect of different doses of sufentanil combined with dexmedetomidine for PCIA on patients after fracture surgery

作　　者：钟永慧 张哲锋 薛荣亮[1] ZHONG Yonghui;ZHANG Zhefeng;XUE Rongliang(Anesthesiology Department,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710000;Anesthesiology Department,Weinan Central Hospital,Weinan 714000,China)

机构地区：[1]西安交通大学第二附属医院麻醉科,陕西西安710000 [2]渭南市中心医院麻醉科,陕西渭南714000

出　　处：《临床医学研究与实践》2023年第3期24-27,共4页Clinical Research and Practice

基　　金：陕西省重点研发计划项目(No.2020SF-087)。

摘　　要：目的观察不同剂量舒芬太尼联合右美托咪定静脉自控镇痛(PCIA)对骨折术后患者的镇痛效果。方法选取2019年11月至2021年6月于本院进行手术治疗的90例骨折患者,以随机数字表法将其分为常规剂量组和低剂量组,各45例。常规剂量组给予2.0μg/kg舒芬太尼+1.5μg/kg右美托咪定PCIA镇痛,低剂量组给予1.0μg/kg舒芬太尼+1.5μg/kg右美托咪定PCIA镇痛。比较两组的干预效果。结果术后6、12、24、48 h,低剂量组的视觉模拟评分法(VAS)、自诉分级评分(OVRS)评分高于常规剂量组,Ramsay镇静评分低于常规剂量组(P<0.05)。术后6、12、24、48 h,低剂量组的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)高于常规剂量组(P<0.05);术后6、12 h,低剂量组的血氧饱和度(SpO_(2))高于常规剂量组(P<0.05)。术后6、12 h,低剂量组的去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)水平均高于常规剂量组(P<0.05)。术后48 h内,低剂量组的PCIA按压次数多于常规剂量组(P<0.05)。低剂量组的不良反应总发生率低于常规剂量组(P<0.05)。结论与常规剂量舒芬太尼联合右美托咪定PCIA相比,低剂量舒芬太尼联合右美托咪定PCIA可显著降低骨折术后患者不良反应发生率,但镇痛、镇静效果略差,术后短期内患者的应激水平偏高,PCIA按压次数更多,仍需进一步完善术后镇痛方案,在保证用药安全性的基础上提升镇痛、镇静效果。Objective To observe the analgesic effect of different doses of sufentanil combined with dexmedetomidine for patient controlled intervenous analgesia(PCIA)on patients after fracture surgery.Methods A total of 90 fracture patients who underwent surgical treatment in our hospital from November 2019 to June 2021 were selected and divided into conventional dose group and low dose group by random number table method,with 45 cases in each group.The conventional dose group was given 2.0μg/kg sufentanil+1.5μg/kg dexmedetomidine for PCIA analgesia,and the low dose group was given 1.0μg/kg sufentanil+1.5μg/kg dexmedetomidine for PCIA analgesia.The intervention effects of the two groups were compared.Results At 6,12,24 and 48 h after operation,the scores of Visual Analogue Scale(VAS)and Observer Verbal Rating Scale(OVRS)in the low dose group were higher than those in the conventional dose group,and the Ramsay sedation score was lower than that in the conventional dose group(P<0.05).At 6,12,24,48 h after operation,the heart rate(HR),mean arterial pressure(MAP)and respiratory rate(RR)in the low dose group were higher than those in the conventional dose group(P<0.05);at 6 and 12 h after operation,the saturation oxygen(SpO_(2))in the low dose group was higher than that in the conventional dose group(P<0.05).At 6,12 h after operation,the levels of norepinephrine(NE),epinephrine(E)and cortisol(Cor)in the low dose group were higher than those in the conventional dose group(P<0.05).Within 48 h after operation,the times of PCIA pressing in the low dose group was more than that in the conventional dose group(P<0.05).The total incidence of adverse reactions in the low dose group was lower than that in the conventional dose group(P<0.05).Conclusion Compared with the conventional dose sufentanil combined with dexmedetomidine for PCIA,low dose sufentanil combined with dexmedetomidine for PCIA can significantly reduce the incidence of adverse reactions in patients after fracture surgery,but the analgesic and sedative effects are sligh

关 键 词：低剂量 舒芬太尼 右美托咪定 静脉自控镇痛 

分 类 号：R614[医药卫生—麻醉学]