CAJ | 학술논문

目的：探讨不同剂量右美托咪定用于老年腰椎术后镇痛的疗效及对患者情绪的影响。方法选择2011年10月至2014年6月医院收治拟行腰椎手术的老年患者60例，随机分为Ⅰ组、Ⅱ组、Ⅲ组，各20例，均给予舒芬太尼和托烷司琼术后镇痛，Ⅰ组、Ⅱ组、Ⅲ组患者右美托咪定的剂量分别为0.1，0.5，1.5μg/（kg·h）。结果Ⅱ组、Ⅲ组在术后4，8，16，32 h时疼痛视觉模拟评分（VAS评分)均低于Ⅰ组，术后4，8 h时Ⅲ组VAS评分均低于Ⅱ组（ P﹤0.05）；术后48 h，3组VAS评分差异不显著（ P﹥0.05）。术后48 h内，患者按压经静脉患者自控镇痛（PCIA）泵的次数及镇痛药物使用总剂量比较，Ⅱ组、Ⅲ组均显著低于Ⅰ组（ P﹤0.05），Ⅲ组PCIA泵按压次数显著低于Ⅱ组（ P﹤0.05），镇痛药物使用总剂量与Ⅱ组相当（ P﹥0.05）。Ⅱ组、Ⅲ组患者睡眠质量指数评分以及焦虑评分均显著低于Ⅰ组（ P﹤0.05），Ⅱ组、Ⅲ组间差异无统计学意义（ P﹥0.05）。治疗过程中，Ⅲ组患者不良反应发生率均高于Ⅰ组和Ⅱ组（ P﹤0.05），Ⅰ组和Ⅱ组间无统计学差异（ P﹥0.05）。结论选用0.5μg/（kg·h）右美托咪定用于老年腰椎术后镇痛的效果佳，总剂量较低，能显著改善患者术后睡眠和焦虑等不良情绪，且安全性好，值得临床推广。
목적：탐토불동제량우미탁미정용우노년요추술후진통적료효급대환자정서적영향。방법선택2011년10월지2014년6월의원수치의행요추수술적노년환자60례，수궤분위Ⅰ조、Ⅱ조、Ⅲ조，각20례，균급여서분태니화탁완사경술후진통，Ⅰ조、Ⅱ조、Ⅲ조환자우미탁미정적제량분별위0.1，0.5，1.5μg/（kg·h）。결과Ⅱ조、Ⅲ조재술후4，8，16，32 h시동통시각모의평분（VAS평분)균저우Ⅰ조，술후4，8 h시Ⅲ조VAS평분균저우Ⅱ조（ P﹤0.05）；술후48 h，3조VAS평분차이불현저（ P﹥0.05）。술후48 h내，환자안압경정맥환자자공진통（PCIA）빙적차수급진통약물사용총제량비교，Ⅱ조、Ⅲ조균현저저우Ⅰ조（ P﹤0.05），Ⅲ조PCIA빙안압차수현저저우Ⅱ조（ P﹤0.05），진통약물사용총제량여Ⅱ조상당（ P﹥0.05）。Ⅱ조、Ⅲ조환자수면질량지수평분이급초필평분균현저저우Ⅰ조（ P﹤0.05），Ⅱ조、Ⅲ조간차이무통계학의의（ P﹥0.05）。치료과정중，Ⅲ조환자불량반응발생솔균고우Ⅰ조화Ⅱ조（ P﹤0.05），Ⅰ조화Ⅱ조간무통계학차이（ P﹥0.05）。결론선용0.5μg/（kg·h）우미탁미정용우노년요추술후진통적효과가，총제량교저，능현저개선환자술후수면화초필등불량정서，차안전성호，치득림상추엄。
Objective To investigate the curative effect of different doses of dexmedetomidine in elderly lumbar surgery and its influence on patients' emotion. Methods 60 cases of elderly patients with lumbar surgery in the hospital from October 2011 to June 2014 were selected and randomly divided into group Ⅰ, group Ⅱ,Ⅲ group, 20 cases in each group. The three groups were given analgesia pump, as well as ondansetron and granisetron sufentanil. The doses of detomidine in group Ⅰ, group Ⅱ, and group Ⅲ were 0. 1, 0. 5, 1. 5 μg/(kg·h) respectively. Results The VAS scores after 4, 8, 16, 32 h of group Ⅱand Ⅲ were all lower than those of group Ⅰ, the VAS scores af-ter 4, 8 h of group Ⅲ were lower than those of group Ⅱ. ( P ﹤ 0. 05 ) . The VAS scores after 48 h had no significant difference among the 3 groups ( P ﹥ 0. 05 ) . After 48 h, the total time and analgesic drug dose of PCIA of group Ⅱand group Ⅲ were significantly fewer than that in group Ⅰrespectively ( P ﹤ 0. 05 ) , and the total time of PCIA of group Ⅲ was significantly fewer than that in group Ⅱ( P ﹤ 0. 05 ) , while the total dose of analgesic drugs of group Ⅲ had no significant difference with that of group Ⅱ( P ﹥ 0. 05 ) . The scores of sleep quality and anxiety were significantly lower in group Ⅱand group Ⅲ than in group Ⅰ( P ﹤ 0. 05 ) , and the difference between group Ⅱ and group Ⅲ was not statistically significant ( P ﹥ 0. 05 ) . During the treatment, the occurrence rate of adverse reac-tions of group Ⅲ was higher than group Ⅰand group Ⅱ, and there was no significant difference between group Ⅰand group Ⅱ( P ﹥ 0. 05). Conclusion 0. 5 μg/ ( kg · h ) concentration and dosage of dexmedetomidine in treating elderlt lumbar postoperative analgesic has the best effect with less total dosage, can significantly improve the postoperative sleep, anxiety and other negative emotions. It is safe and is worth of clinical promotion.