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。

参考文献： [1]Rafiq S，？Steinbrüchel DA，？Wanscher MJ，et

al.Multimodal analgesia versus traditional opiate based

analgesia after cardiac surgery， a randomized controlled

trial[J].J Cardiothorac Surg，2014，9：52.

[2]裴皓.盐酸右美托咪定的药理作用与临床应用[J]，医药导报，2010，29（12） ：1605-1609.

[3] Sim JH，？Yu HJ，？Kim ST.The effects of different？loading？doses of？dexmedetomidine？on sedation[J].Korean J

Anesthesiol，2014，67（1）：8-12.

[4] 张建余，张兆平，房宁宁，等.右美托咪定复合喷他佐辛用于患者自控镇痛[J].中华临床医师杂志（电子版），2012，23：7861-7863.

[5] Erol DD. The analgesic and antiemetic efficacy of

gabapentin or ergotamine/caffeine for the treatment of postdural

puncture headache[J].Adv Med Sci，2011，56（1）：25-29.

[6]Kim JH1，？Jang SY，？Kim MJ，？et al. Comparison

of pain-relieving effects of？fentanyl？versus？ketorolac？after eye amputation surgery[J].Korean J Ophthalmol，2013，27（4）：229-234.

[7] Zhao LY，？Ye TH，？Zhang YZ，et al. Combination

of morphine with low-dose？naloxone？for intravenous

patient-controlled analgesia[J].Zhongguo Yi Xue Ke Xue Yuan Xue Bao，2005 ，27（2）：228-231.

[8]姚鹏，孟凌新，崔健君.阿片受体激动药伍用小剂量拮抗药用于镇痛的研究进展[J].国外医学，麻醉学与复苏分册，2004，23（2）：80-83.

[9]Akhavanakbari G，Mohamadian A，Entezariasl

M.Evaluation the effects of？adding？ketamine？to？morphine？in intravenous？patient-controlled analgesia？after

orthopedic surgery[J].Perspect Clin Res，2014，5（2）：85-87.

[10]Yamazaki K，？Kaneda T，Suzuki T. Usefulness of

dditional？dexmedetomidine？administration？in？postoperative painmanagement after the scoliosis

surgery[J].Masui，2014，63（7）：783-788.

[11] Unlugenc H， Gunduz M， Guler T， et al. The effect

of pre-anaesthetic administration of intravenous

dexmedetomidine on postoperative pain in patients receiving

patient-controlled morphine[J].Eur J Anaesthesiol，2005，22（5）：

386?C391.

[12].Madhere M，？Vangura D，？Saidov A.

Dexmedetomidine？as？sole？agent for？awake？fiberoptic？intubation？in a patient with local anesthetic allergy[J].J