CAJ | 학술논문

目的：评价右美托咪定复合舒芬太尼在下肢骨折患者术后静脉自控镇痛（PCIA）中的应用效果。方法150例择期全麻下行下肢骨折切开复位内固定患者，美国麻醉师协会（ASA）分级为Ⅰ~Ⅱ级，随机均等分为5组：不同剂量舒芬太尼组（S1、S2组），舒芬太尼复合不同剂量右美托咪定组（M1、M2、M3组）。于手术结束即刻行 PCIA，均用生理盐水稀释至100 ml，首次剂量均为舒芬太尼0.1μg/ kg，静脉镇痛泵背景输注速度2 ml/ h，自控给药剂量0.5 ml，锁定时间15 min。分别于术后1（T1）、3（T2）、6（T3）、12（T4）、24（T5）和48 h（T6）各时间点，采用视觉模拟评分法（VAS）评价患者疼痛程度及 Ramsay 镇静评分评价患者镇静程度；记录患者术后48 h 内 PCIA 按压总次数及地佐辛用量；并记录术后48 h内恶心、呕吐、皮肤瘙痒、呼吸抑制和低血压的发生情况。结果与 S1、M1组比较，S2、M2、M3组 T1~ T6 VAS 评分降低（P <0.05），M3组 T1~ T6 Ramsay 评分升高（P <0.05），S2、M2、M3组 PCIA 按压总次数及地佐辛消耗量均减少（ P <0.05）。M2组未出现并发症，S2组较 S1、M1、M2、M3组恶心呕吐、皮肤瘙痒、呼吸抑制发生例数增加（P <0.05）；M2、M3组较 S1组恶心呕吐发生例数减少（P <0.05）；M3组较 M2组呼吸抑制发生例数增加（P <0.05）；M3组较 S1、S2、M1、M2组低血压发生例数增加（P <0.05）。结论2μg/ kg 舒芬太尼联合2μg/ kg 右美托咪定镇痛效果满意，副反应少，是骨科患者术后镇痛的较佳配方。
목적：평개우미탁미정복합서분태니재하지골절환자술후정맥자공진통（PCIA）중적응용효과。방법150례택기전마하행하지골절절개복위내고정환자，미국마취사협회（ASA）분급위Ⅰ~Ⅱ급，수궤균등분위5조：불동제량서분태니조（S1、S2조），서분태니복합불동제량우미탁미정조（M1、M2、M3조）。우수술결속즉각행 PCIA，균용생리염수희석지100 ml，수차제량균위서분태니0.1μg/ kg，정맥진통빙배경수주속도2 ml/ h，자공급약제량0.5 ml，쇄정시간15 min。분별우술후1（T1）、3（T2）、6（T3）、12（T4）、24（T5）화48 h（T6）각시간점，채용시각모의평분법（VAS）평개환자동통정도급 Ramsay 진정평분평개환자진정정도；기록환자술후48 h 내 PCIA 안압총차수급지좌신용량；병기록술후48 h내악심、구토、피부소양、호흡억제화저혈압적발생정황。결과여 S1、M1조비교，S2、M2、M3조 T1~ T6 VAS 평분강저（P <0.05），M3조 T1~ T6 Ramsay 평분승고（P <0.05），S2、M2、M3조 PCIA 안압총차수급지좌신소모량균감소（ P <0.05）。M2조미출현병발증，S2조교 S1、M1、M2、M3조악심구토、피부소양、호흡억제발생례수증가（P <0.05）；M2、M3조교 S1조악심구토발생례수감소（P <0.05）；M3조교 M2조호흡억제발생례수증가（P <0.05）；M3조교 S1、S2、M1、M2조저혈압발생례수증가（P <0.05）。결론2μg/ kg 서분태니연합2μg/ kg 우미탁미정진통효과만의，부반응소，시골과환자술후진통적교가배방。
Objective To investigate the effect of combining dexmedetomidine(Dex)and sufentanil on postopera-tive patient-controlled intravenous analgesia(PCIA)in patients of lower limb fracture. Methods One hundred and fifty patients,ASAⅠ ~ Ⅱ,undergoing lower limb fracture surgery,were randomly divided into five groups:different doses of sufentanil groups(S1,S2 group)and sufentanil combining with different doses of dexmedetomidine groups (M1,M2,M3 group). At the end of the surgery,patients immediately received postoperative PCIA. All drugs were diluted with saline to 100 ml. PCIA was set as follows:background infusion 2 ml/ h;bolus dose 0. 1 μg / kg;PCA dose 0. 5 ml;loekout interva 15 min. The scores of VAS and RSS were recorded at 1,3,6,12,24 and 48 hours after PCIA. The press number,dezocine consuming and the incidence rate of the nausea,vomiting,pruritus,respiratory depression and hypotension were recorded for 48 hours. Results Compared with group S1,M1,the VAS score was significantly decreased at T1 ~ T6 in S2,M2,M3(P < 0. 05). The RSS score was significantly increased at T1~ T6 in M3(P < 0. 05). The press number,and dezocine consuming was significantly decreased at T1 ~ T6 in S2, M2,M3(P < 0. 05). There were no complications in group M2. The occurrence of nausea,vomiting,pruritus,re-spiratory depression was significantly decreased in S1,M1,M2,M3 than S2(P < 0. 05). Compared with S1,the oc-currence of nausea and vomiting was significantly decreased in M2,M3(P < 0. 05). The occurrence of respiratory depression in M3 Group was significantly higher than M2 group(P < 0. 05). The occurrence of hypotension in M3 Group was significantly higher than other groups(P < 0. 05). Conclusion Sufentanil 2 μg / kg plus Dex 2 μg / kg has better satisfactory analgesia effect and less side effect. It is a better compound for orthopaedic.