桂靖　董巍檑

摘要： 目的： 研究右美托咪定對老年患者人工股骨头置换术术后硬膜外镇痛的影响。 方法：将80例择期腰硬联合阻滞麻醉下行人工股骨头置换术老年患者随机分为两组：R组（罗哌卡因–舒芬太尼组）40例；D组（右美托咪定 –罗哌卡因–舒芬太尼组）40例。R组采用0.1%罗哌卡因+0.5μg/ml舒芬太尼行自控硬膜外镇痛，D组采用1.0μg/ kg右美托咪定+0.1%罗哌卡因+0.5μg/ml舒芬太尼行自控硬膜外镇痛。记录术后8、16、24（T1、T2、T3）小时的疼痛、镇静评分，记录镇痛液消耗量， 术后呕吐次数。疼痛情况用水平视觉模拟评分法（VAS）评估，镇静程度以Ramsay评分法分类。记录术后24、48、72（T3、T4、T5）小时的简易精神状态检查（MMSE）评分。 结果：D组各时点VAS评分普遍低于R组，其中T2、T3时点组间有显著性差异（P﹤0.05）。两组病人Ramsay评分比较无显著性差异（P﹥0.05），两组病人均未出现镇静过度。D组病人术后各时点镇痛液消耗量普遍低于R组，T1、T2、T3时点均有组间显著性差异（P﹤0.05）。D组病人术后各时点呕吐评分普遍低于R组，其中T1、T2、T3时点均有组间显著性差异（P﹤0.05）。D组病人术后T3、T4、T5时点MMSE评分均高于R组，均有组间显著性差异（P﹤0.05）。 结论：右美托咪定应用在老年患者人工股骨头置换术术后硬膜外镇痛中是安全的，可以增强术后镇静镇痛的效果，减少局麻和阿片类药物的剂量，并降低呕吐、POCD等不良反应的发生率。

关键词：右美托咪定 ； 人工股骨头置换术； 硬膜外镇痛

Abstract：Objective To study the effects of dexmedetomidine on the postoperative epidural analgesia after artificial femoral head replacement in old patients.

Methods 80 old patients received artificial femoral head replacement under combined spinalepidural anesthesia were rondomly divided into 2 groups： R group （Ropivacaine–sufentanil group，40）， D group （dexmedetomidine–Ropivacaine–sufentanil group，40）.The self-controlled epidural analgesia after surgery was performed on the way（R group ： 0.1% ropivacaine+0.5μg/ml sufentanil； D group ： 1.0μg/ kg dexmedetomidine +0.1% ropivacaine+0.5μg/ml sufentanil） The score of ache ， sedation and vomit， the consumption of analgesic were detected at 8h，16h，24h （T1、T2、T3）after surgery. The score of ache were assessmented by VAS， the score of sedation were assessmented by Ramsay. the score of MMSE were detected at 24h，48h，72h （T3、T4、T5）after surgery. Results The score of VAS in D group decreased generally， decreased significantly compared with R group at T2、T3 after surgery（P﹤0.05）.the score of Ramsay in D group did not increase significantly compared with R group （P﹥0.05），excessive sedation did not appear in two groups. the consumption of analgesic in D group decreased significantly compared with R group at T1、T2、T3 after surgery（P﹤0.05）. The score of vomit in D group decreased significantly compared with R group at T1、T2、T3 after surgery（P﹤0.05）. The score of MMSE in D group increased significantly compared with R group at T3、T4、T5 after surgery（P﹤0.05）. Conclusion the Effects of dexmedetomidine on the postoperative epidural analgesia after artificial femoral head replacement in old patients is safe， dexmedetomidine can increase the effects of analgesia and sedation，decrease the dose of local anesthesia drugs and opioids，decrease the incidence of vomit and POCD.

Keywords： dexmedetomidine ；artificial femoral head replacement； epidural analgesia

随着中国社会老龄化的日益加重，老年患者手术逐年增多。术后急性疼痛是机体对组织损伤、内脏扩张的复杂生理反应，表现为自主神经、心理及行为学方面的改变，从而引起不愉快或不需要的感觉或情绪体验[1]。……