右美托咪定增强舒芬太尼术后镇痛(PCA)效果的临床观察
摘要：目的 观察右美托咪定增强舒芬太尼用于术后镇痛的效果和副作用。方法 全组50例患者，男、女兼有，年龄20～65岁，ASAI～II级，全麻下行外科手术。随机均分为两组，每组25例。S组―镇痛泵100ml0.9%氯化钠溶液中+盐酸舒芬太尼80μg（0.8μg/ml）；SD组―镇痛泵100m0.9%氯化钠溶液中+盐酸舒芬太尼80μg+盐酸右美托咪定400μg（4μg/ml）。观察并记录：首次PCA时间；PCA有效次数；24h盐酸舒芬太尼总用量和不同时段VAS评分；MAP、HR和呼吸的变化。结果 SD组患者术后24h内盐酸舒芬太尼用量明显少于S组（P<0.01）。术后8h内，SD组血液动力学变化明显较术前降低或减少，分别P<0.05。SD组在术后24h内副作用发生率显著低于S组（P<0.05）；未发现明显的循环抑制、过度镇静和呼吸抑制现象。结论 盐酸右美托咪定与盐酸舒芬太尼联合用于患者术后镇痛可增强盐酸舒芬太尼镇痛效果，提高术后镇痛质量、减少盐酸舒芬太尼用量及副作用。
关键词：术后镇痛；PCA；右美托咪定；舒芬太尼
Clinical Observation of Combining Dexmedetomidine and
Sufentanyl for Intravenous Patient-controlled Analgesia WANG Hua1，FANG Guo-ping2，ZHANG Zhao-ping3，
GU Mei-rong3，SUN Guo-hua3
（1.Department of Anesthesiology， Fenghuang Zhongliu
Hospital of Hefei，Hefei 230001，Anhui，China；
2.Department of Anesthesiology，Hefei Zhongshan
Hospital，Hefei 230001，Anhui，China；
3.Department of Anesthesiology，Wuxi City People's
Hospital of Nanjing Medical University，Wuxi 214000，Jiangsu，China）
Abstract：Objective The aim of this study was to evaluate
the effect of combining dexmedetomidine and sufentanyl for
intravenous patient- controlled analgesia. Methods 50 ASAⅠorⅡ undergoing abdominal surgery were allocated to receive
either sufentanyl 0.8μg/ml alone （Group S） or sufentanyl 0.8μg/ml plus dexmedetomidine 4μg /ml（Group SD） for
postoperative i.v. PCA，which was programmed to deliver
loading dose of 3 ml with a 15 min lockout interval and 2ml/h
background infusion. Cumulative PCA requirements， pain
intensities， cardiovascular and respiratory variables， and
PCA-related adverse events were recorded for 24 h after
operation. Results Compared with Group S， patients in Group
SD required less sufentanyl during the 0?C24 h postoperative period and reported significantly lower pain levels throughout
the study. Whereas levels of sedation were similar between the
groups at each observational time point， decreases in heart rate
and mean blood pressure from presurgery baseline at 2， 4， and
8h after operation were significantly greater in Group SD . The
0?C24 h incidence of nausea and pruritus was significantly
lower in Group SD （P<0.05）. There was no bradycardia，
hypotension， over sedation， or respiratory depression.
Conclusion The addition of dexmedetomidine to i.v. PCA
sufentanyl resulted in superior analgesia， significant sufentanyl
sparing， less sufentanyl -induced nausea and pruritus was
devoid of additional sedation and untoward haemodynamic
changes.
Key words：Analgesia， postoperative； Patient-controlled
analges；Dexmedetomidine； Sufentanyl 总之，Dex复合盐酸舒芬太尼可减少或节俭舒芬太尼用量，增强镇痛效果，提高镇痛质量；减少与盐酸舒芬太尼有关的副作用，提高术后镇痛患者的满意度。该药对血液动力学的影响和过度镇静作用是可控的、安全的。因此，我们认为Dex辅助盐酸舒芬太尼用于术后镇痛是可行的；两药联用可取长补短，有协同作用。Dex的最佳剂量，有待进深入研究和探讨。
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