右旋美托咪啶对老年患者全髋置换术后芬太尼静脉自控镇痛效果的影响

摘要

Objective To investigate the effect of a continuous infusion of low-dose dexmedetomidine on patient-controlled analgesia (PCA) with fentanyl in elderly patients after total hip replacement. Methods Forty patients (ASA I-II) aged 66-81 years after total hip replacement were randomized equally into the control and test groups. The patients in the test group received continuous infusion of dexmedetomidine at the rate of 0.2 μg ? Kg-1 ■ h-1 from the beginning to the end of PCA with fentanyl after the surgery, while those in the control group received normal saline. The cumulative fentanyl dose, VAS pain scores and Ramsay sedation score were recorded at 0, 4, 8,12 and 24 h after the surgery. Results All the patients in the two groups reported good pain relief and none needed additional fentanyl. The VAS pain score was significantly lower (.P＜0.05 or 0.01), while the Ramsay sedation scores higher (Ip＜0.05) in the test group than in the control group. The cumulative fentanyl dose was significantly lower in the test group (P＜0.05 or 0.01). The incidence of such adverse effects as nausea and vomiting was significantly lower in the test group (P＜0.05). Conclusion PCA with fentanyl combined with low-dose dexmedetomidine infusion is safe for elderly patients, and can decrease fentanyl consumption and improve the effect of PCA with fentanyl.%目的 观察右旋美托咪啶对老年患者全髋关节置换术后芬太尼静脉自控镇痛效果的影响.方法 ASAI～Ⅱ级择期全髋置换手术后老年患者40例,随机分为对照组和试验组,术后启动PCA时分别以0.2 μg/(kg·h)持续输注右旋美托咪啶和生理盐水至PCA结束.记录两组自觉伤口疼痛PCA启动时(0)、4、8、12、24h时VAS评分、芬太尼累积用量、Ramsay评分等;记录术后镇痛24 h期间的不良反应和异常情况及治疗措施.结果 两组术后镇痛效果良好,但试验组PCA后各时点VAS评分小于对照组(P＜0.05或0.01),而Ramsay镇静评分大于对照组(p＜0.05).试验组术后12 h和24 h芬太尼累积用量少于对照组(P＜0.05或0.01),减少21.4%.试验组PCA恶心/呕吐等不良反应发率生低于对照组(P＜0.05).结论 持续输注右旋美托咪啶联合芬太尼PCA模式用于老年患者静脉镇痛安全有效,可减少芬太尼用量,不良反应发生率降低.