甘立书 韦信洪 陆健君 罗成 王启明

【摘要】 目的：探究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。方法：回顾性分析2017年10月-2019年8月在本院择期全麻下开展骨科手术治疗患者280例的临床资料。按随机数字表法将其分为A、B、C、D组，每组70例。A组给予以舒芬太尼为主的镇痛方案，在此基础上，B组给予右美托咪定0.1 μg/（kg·h），C組给予右美托咪定0.15 μg/（kg·h），D组给予右美托咪定0.2 μg/（kg·h）。比较四组术后各时间点的镇痛、镇静效果、安全性和术后48 h自控镇痛按压次数。结果：C、D组术后各时间点VAS评分均低于同期A组，且低于同期B组（P<0.05）;C、D组各时间点的VAS评分比较，差异无统计学意义（P>0.05）。B、C、D组术后各时间点的Ramsay评分均高于同期A组（P<0.05）;C组术后各时间点的Ramsay评分均高于同期B组，且D组高于B组、C组（P<0.05）。D组自控镇痛按压次数均少于C组（P<0.05）;C组、D组自控镇痛按压次数均少于A组与B组，且B组少于A组（P<0.05）。B、C组的不良反应率均低于A组与D组（P<0.05）。结论：对全麻骨科术后患者于静脉自控镇痛中于常规以舒芬太尼为主的镇痛方案基础上加用0.15 μg/（kg·h）右美托咪定可获得更为满意的镇痛及镇静效果，并可减少自控镇痛按压次数，且治疗安全可靠。

【关键词】 右美托咪定 全麻骨科手术 术后静脉自控镇痛

Effect of Different Doses of Dexmedetomidine on Postoperative Patient-controlled Intravenous Analgesia after Orthopedic Surgery under General Anesthesia/GAN Lishu， WEI Xinhong， LU Jianjun， LUO Cheng， WANG Qiming. //Medical Innovation of China， 2021， 18（13）： 0-036

[Abstract] Objective： To explore the effect of different doses of Dexmedetomidine on postoperative patient-controlled intravenous analgesia after orthopedic surgery under general anesthesia. Method： The clinical data of 280 patients who underwent orthopedic surgery under elective general anesthesia in our hospital from October 2017 to August 2019 were retrospectively analyzed. According to random number table method， they were divided into group A， B， C and D， with 70 cases in each group. Group A was given Sufentanil based analgesia. On this basis， group B was given Dexmedetomidine 0.1 μg/（kg·h）， group C was given Dexmedetomidine 0.15 μg/（kg·h）， group D was given Dexmedetomidine 0.2 μg/（kg·h）. The analgesic， sedative effects at different time points， safety and 48 h after surgery the number of patient-controlled analgesia compressions were compared among the four groups. Result： VAS scores in groups C and D were lower than those in group A and B at all time points （P<0.05）. There was no significant difference in VAS scores between group C and D at each time point （P>0.05）. Ramsay scores at all time points in groups B， C and D were higher than those in group A （P<0.05）. Ramsay scores at all time points of group C were higher than those of group B， and those of group D were higher than those of group B and C （P<0.05）. The number of patient-controlled analgesia compressions in group D was less than that in group C （P<0.05）. The numbers of patient-controlled analgesia compressions in group C and D were less than those in group A and B， and group B was less than group A （P<0.05）. Adverse reaction rates in groups B and C were lower than those in group A and D （P<0.05）. Conclusion： For patients after orthopedic surgery under general anesthesia， 0.15 μg/（kg·h） Dexmedetomidine in intravenous controlled analgesia on the basis of conventional Sufentanil based analgesia program can obtain more satisfactory analgesic and sedative effects， and can reduce the numbers of patient-controlled analgesia compressions， and the treatment is safe and reliable.

[Key words] Dexmedetomidine Orthopedic surgery under general anesthesia Postoperative patient-controlled intravenous analgesia

First-authors address： The First Affiliated Hospital of Guangxi University of Chinese Medicine， Nanning 530023， China

doi：10.3969/j.issn.1674-4985.2021.13.008

近年来，随着我国经济快速发展及进入老龄化社会，骨折、关节退行性损伤等骨科疾病发生率逐年递增，全麻下骨外科手术则成为临床主要治疗手段，但骨科手术创伤较大、术后疼痛强烈，致使患者对术后镇痛要求较高。临床研究证实，骨科术后进行合理镇痛镇静治疗，有助于降低术后痛感，可促进患者早期肢体功能锻炼，利于术后康复，但不同给药剂量在镇痛、安全等方面具有一定差异性。右美托咪定是一种新型高选择性α2肾上腺能受体激动剂，可用于临床镇静、镇痛、麻醉辅助，减少麻醉药剂量，发挥良好的协同作用。自控镇痛是目前常用的术后镇痛方法，对外科术后镇痛剂及镇静效果被广泛认可[1]。本研究将对近年在本院280例接受全麻骨科手术患者，于术后经分组分别采用不同剂量的右美托咪定经静脉自控镇痛，以评估不同剂量右美托咪定自控镇痛的镇痛镇静效果及安全性，为临床合理给药提供理论依据，现报道如下。……