右美托咪啶对腰椎融合术后舒芬太尼静脉自控镇痛效果的影响

Sufentanil combined with low dose dexmedetomidine in patient-controlled analgesia for patients undergoing lumbar spinal fusion surgery

关键词:  右美托咪啶  舒芬太尼  腰椎手术  镇痛  患者自控

Key words:  dexmedetomidine  sufentanil  lumbar spinal fusion surgery  analgesia, patientcontrolled

摘要:

目的观察右美托咪啶持续低剂量输注对腰椎术后舒芬太尼静脉自控镇痛效果的影响。方法ASAⅠ~Ⅱ级择期腰椎减压内固定术患者42名,年龄28~65岁,随机分为舒芬太尼组（对照组）和右美托咪啶＋舒芬太尼组（试验组）。舒芬太尼累计用量,Ramsay评分,术后1、4、8、12、24 h两组自觉伤口疼痛的VAS评分,记录术后24 h期间的不良反应和异常情况。结果两组术后镇痛效果良好,但试验组术后各时点VAS评分小于对照组（P〈0.05）,而Ramsay镇静评分大于对照组（P〈0.05）。试验组术后12、24 h舒芬太尼累积用量小于对照组（P〈0.05）,各减少20.0%和26.7%。试验组恶心呕吐等不良反应发生率低于对照组（P〈0.05）。结论右美托咪啶辅助舒芬太尼用于腰椎术后静脉自控镇痛安全有效,可以减少术后舒芬太尼用量,降低不良反应发生率,患者舒适度、满意度增加。

Abstract:

Objective To investigate the efficacy and safety of sufentanil combined with dexmedetomidine in patient-controlled analgesia （PCA） for patients undergoing lumbar spinal fusion surgery. Methods Forty two patients （ASA I -I1 ） aged 28 -65 years after lumber spinal fusion surgery were randomly divided into the test and control groups. The patients in the test group received continuous infusion of sufentanil and low dose dexmedetomidine after the surgery, while those in the control group received continuous infusion of sufentanil. The cumulative sufentanil dose, VAS pain score and Ramsay sedation score were recorded at 1,4, 8, 12, 24 h after the surgery. Results Both groups reported good pain relief and no additional sufentanil was needed. The VAS pain score was significantly lower （P〈0.05 ）, while the Ramsay sedation score higher （P〈0.05 ） in the test group than those in the control group. The cumulative sufentanil dose was significantly lower in the test group （P〈0.05 ）. The incidence of adverse effects including nausea and vomiting was significantly lower in the test group （P〈0.05 ）. Conclusion PCA with sufentanil combined with low-dose dexmedetomidine infusion is safe for patients undergoing lumbar spinal fusion surgery, and can decrease sufentanil consumption and improve the effect of PCA with sufentanil.