【摘要】 目的比较3种剂量(0. 5、0. 75和1μg·kg-1)舒芬太尼联合右美托咪定在ASAⅠ或Ⅱ级脊柱手术患者术后静脉自控镇痛(PCIA)的效果。方法选择2015年1月至2017年6月进行脊柱手术并行PCIA镇痛治疗的年龄为30～75岁的患者96例,随机分为A、B、C组,分别应用0. 5、0. 75和1μg·kg-13种不同剂量的舒芬太尼联合和1. 5μg·kg-1右美托咪定用于PCIA,记录患者PICA应用前(T0)和应用后2 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)和48 h(T5)的呼吸循环指标(呼吸频率、血氧饱和度、心率和平均动脉压),疼痛程度(VAS评分)、镇静程度(Ramsay评分)、PCIA使用次数、布托啡诺使用次数以及PCIA暂停事件等。结果 C组的心率、平均动脉压、呼吸频率和脉搏氧饱和度等呼吸循环指标与治疗前以及和A、B组相比,差异均存在统计学意义(P <0. 05); A、B 2组之间差异未见统计学意义(P> 0. 05)。应用PCIA治疗后,3组患者VAS评分明显降低,Ramsay评分显著升高;其中,B组和C组VAS评分显著低于A组,Ramsay评分显著高于A组(P <0. 05)。B组和C组PCIA按压次数和布托啡诺使用次数明显低于A组(P <0. 05); B组和C组间差异未见统计学意义(P> 0. 05)。C组不良反应发生率为31. 25%,显著高于A组和B组(P <0. 05),A组和B组间差异未见统计学意义(6. 25%和9. 38%,P> 0. 05)。结论在ASAⅠ或Ⅱ级脊柱手术患者术后采用0. 75μg·kg-1舒芬太尼联合1. 5μg·kg-1右美托咪定的PCIA方案的静脉镇痛、镇静效果比较好,不良反应发生风险较低。更多还原

【Abstract】 AIM To evaluate the efficacy of 3 doses( 0. 5,0. 75 and 1 μg·kg-1) of sufentanil combined with dexmedetomidine in patients with ASA Ⅰ or Ⅱ spinal surgery by patient controlled intravenous analgesia( PCIA). METHODS A total of 96 patients aged between 30 and 75 years who underwent spinal surgery with PCIA from January 2015 to June 2017 were randomly divided into group A,group B and group C,and were treated with 0. 5,0. 75 and 1 μg·kg-1of different doses of sufentanil combined with 1. 5 μg·kg-1dexmedetomidine for PCIA,respectively. The respiratory and circulatory indexes( such as respiratory rate,oxygen saturation,heart rate and mean arterial pressure) before and after treatment( T0) and 2 h( T1),6 h( T2),12 h( T3),24 h( T4) and48 h( T5),pain degree( VAS),degree of sedation( Ramsay score),number of PCIA use,number of use of butorphanol and PCIA pause events were recorded. RESULTS There were significant differences in heart rate,mean arterial pressure,respiratory rate and oxygen saturation between the group C and other 2 groups( P < 0. 05),but no significant difference between group A and group B( P > 0. 05). After treatment with PCIA,the VAS was significantly lower and the Ramsay score was significantly higher in all the 3 groups. The VAS of the group B and the group C was significantly lower than that of the group A and the Ramsay score was significantly higher than that of the group A( P < 0. 05). The number of PCIA in group B( 8. 9 ± 1. 5 and 1. 7 ± 1. 2) and group C( 7. 6 ± 1. 4and 1. 5 ± 0. 9) was significantly lower than that in group A( 12. 2 ± 2. 5 and 3. 2 ± 1. 4)( P < 0. 05),and there was no significant difference between group B and group C( P > 0. 05). The incidence of adverse reactions in group C was 31. 25%,which was significantly higher than that in group A and B( P < 0. 05). There was no significant difference between group A and group B( 6. 25% and 9. 38,P > 0. 05). CONCLUSION For patients with ASA Ⅰ/Ⅱ after spine surgery,0. 75 μg·kg-1sufentanil combined with dexmedetomidine has a better analgesic effect and satisfactory sedative effect with lower occurrence of risk of adverse reactions.更多还原