CAJ | 학술논문

目的：观察右美托咪啶复合舒芬太尼用于胸椎结核术后患者自控静脉镇痛（PCIA）的临床效果。方法将2011年6月至2013年9月收治的60例胸椎结核术后PCIA患者随机双盲分为三组，每组20例。A组（对照组）使用舒芬太尼0.06μg/（kg·h），以生理盐水稀释至100 mL；B组使用舒芬太尼0.06μg/（kg·h）、右美托咪啶0.05μg/（kg·h），C组使用舒芬太尼0.06μg/（kg·h）、右美托咪啶0.10μg/（kg·h），B、C组均加入托烷司琼5 mg，以生理盐水稀释至100 mL。监测并记录三组患者 PCIA 后2、4、6、12、24 h 平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、视觉模拟评分（VAS）和Ramsay镇静评分、24 h内总按压次数、舒芬太尼用量及不良反应等情况。结果 B、C组患者不同时间点MAP与A组比较，差异均无统计学意义（P＞0.05），而HR在PCIA后4、6、12、24 h低于A组，差异均有统计学意义（P<0.05）， SpO2在PCIA后4、6、12、24 h高于A组，差异均有统计学意义（P<0.05）；PCIA后4、6、12、24 h VAS由高至低依次为A、B、C组，Ramsay镇静评分由高至低依次为C、B、A组，差异均有统计学意义（P<0.05）；24 h内PCIA总按压次数，舒芬太尼用量，恶心、呕吐、皮肤瘙痒发生率由高至低依次为A、B、C组，差异均有统计学意义（P<0.05）。结论右美托咪啶可增强胸椎结核术后舒芬太尼PCIA效果，减少舒芬太尼用量，降低不良反应发生率。
목적：관찰우미탁미정복합서분태니용우흉추결핵술후환자자공정맥진통（PCIA）적림상효과。방법장2011년6월지2013년9월수치적60례흉추결핵술후PCIA환자수궤쌍맹분위삼조，매조20례。A조（대조조）사용서분태니0.06μg/（kg·h），이생리염수희석지100 mL；B조사용서분태니0.06μg/（kg·h）、우미탁미정0.05μg/（kg·h），C조사용서분태니0.06μg/（kg·h）、우미탁미정0.10μg/（kg·h），B、C조균가입탁완사경5 mg，이생리염수희석지100 mL。감측병기록삼조환자 PCIA 후2、4、6、12、24 h 평균동맥압（MAP）、심솔（HR）、맥박혈양포화도（SpO2）、시각모의평분（VAS）화Ramsay진정평분、24 h내총안압차수、서분태니용량급불량반응등정황。결과 B、C조환자불동시간점MAP여A조비교，차이균무통계학의의（P＞0.05），이HR재PCIA후4、6、12、24 h저우A조，차이균유통계학의의（P<0.05）， SpO2재PCIA후4、6、12、24 h고우A조，차이균유통계학의의（P<0.05）；PCIA후4、6、12、24 h VAS유고지저의차위A、B、C조，Ramsay진정평분유고지저의차위C、B、A조，차이균유통계학의의（P<0.05）；24 h내PCIA총안압차수，서분태니용량，악심、구토、피부소양발생솔유고지저의차위A、B、C조，차이균유통계학의의（P<0.05）。결론우미탁미정가증강흉추결핵술후서분태니PCIA효과，감소서분태니용량，강저불량반응발생솔。
Objective To observe the clinic effect of dexmedetomidine combined with sufentanil for patient-controlled intravenous analgesia(PCIA) after thoracic tuberculosis surgery. Methods Sixty PCIA patients after thoracic tuberculosis surgery from June 2011 to September 2013 were randomly divided into 3 groups,20 cases in each group. Group A(the control group) was given 0.06μg/(kg·h)sufentanil deliquated to 100 mL with normal saline.Group B with 0.06μg/(kg·h) sufentanil combined with 0.05μg/(kg·h)dexmedetomidine. Group C with 0.06μg/(kg·h) sufentanil combined with 0.10μg/(kg·h) dexmedetomidine,all of which were added with 5 mg tropisetron deliquated to 100 mL with normal saline ,too. The mean arterial pressure (MAP),hear rate(HR),saturation of pulse oximetry(SpO2),VAS score,Ramsay sedation score,cumulative compression frequency within 24 hours,sufentanil consumption doses and side effects were also recorded at 2nd ,4th,6th,12th and 24th hours after the beginning of PCIA. Results There were no statistial significance in differences of MAP at various time in the group B ,C compared with group A(P>0.05). The HR in group B,C were significantly lower than those in group A at 2nd,4th,6th,12th and 24th hours af-ter PCIA while SpO2 in group B,C was higher than that of the control group at 4th,6th hours after PCIA,both of which had a sta-tistical significance in difference(P<0.05). It ranked from high to low of group A,B and C in VAS at 4th,6th,12th and 24th hours after PCIA,in turn,the Ramsay sedation score ranked. The difference was statistically significant (P<0.05). cumulative compression frequency within 24 hours,sufentanil consumption dosage and side effects such as nausea,vomiting and pruritus ordered group C, group B,group A,whose differece had a statistical significance(P<0.05). Conclusion Dexmedetomidine may strenghten intrave-nous sufentanil PCIA analgesic efficacy after thoracic tuberculosis surgery ,decrease sufentanil consumption doses and reduce the incidence of adverse effect.