微创医学

目的观察不同剂量右美托咪定复合舒芬太尼对胸腔镜手术患者术后镇痛的影响。方法择期行胸腔镜手术患者90例，随机均分为三组，每组30例。术后镇痛分别给予右美托咪定1.5 μg/(kg·d)+舒芬太尼1 μg/(kg·d)(S1组)、右美托咪定1 μg/(kg·d)+舒芬太尼1 μg/(kg·d) (S2组)和右美托咪定0.5 μg/(kg·d)+舒芬太尼1 μg/(kg·d) (S3组)。手术结束时连接静脉镇痛泵行自控静脉镇痛,背景输注流速 3 ml/h，单次追加药量1 mL，锁定时间15 min，总容量150 mL。分别记录三组患者术后 2 h(T1)、4 h(T2)、8 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)的 VAS 疼痛评分和Ramsay镇静评分，记录术后不良反应的发生率。结果与S1组比较，S2组和S3组T1～4时的VAS评分均较高(P＜0.05)；S2组T1～6时较S3组的VAS评分降低(P＜0.05)。与S1组比较，S2组和S3组T1～6时的Ramsay评分均较低(P＜0.05)；S2组T1～6时较S3组的Ramsay评分升高(P＜0.05)。S1组心动过缓和嗜睡的发生率明显高于S2组和S3组(P＜0.05)。结论应用1 μg/(kg·d)右美托咪定复合舒芬太尼对胸腔镜手术患者术后镇痛的效果显著，同时其心动过缓和嗜睡等不良反应的发生率较低。

ObjectiveTo observe the effects of different doses of dexmedetomidine combined with sufentanil on postoperative analgesia in patients undergoing thoracoscope surgery. MethodsNinety patients undergoing thoracoscope surgery were randomly divided into three groups, 30 cases in each group. Postoperative analgesia was given different doses of drugs: 1.5 μg/(kg·d) dexmedetomidine + 1 μg/(kg·d) sufentanil(group S1), 1 μg/(kg·d) dexmedetomidine + 1μg/(kg·d) sufentanil(group S2) and 0.5 μg/(kg·d) dexmedetomidine + 1 μg/(kg·d) sufentanil(group S3). Patient-controlled intravenous analgesia pump was applied at the end of surgery. The drugs in each group were diluted to 150 mL and infused by a pump at a rate of 3 ml/h with a patient-controlled analgesia (PCA)bolus of 1 mL and lock time of 15 minutes. VAS and Ramsay scores at 2 h (T1), 4 h (T2), 8 h (T3), 12 h (T4), 24 h (T5) and 48 h (T6) after surgery were estimated. Postoperative adverse events were recorded and analyzed. ResultsCompared with group S1, VAS scores in group S2 and group S3 were significantly higher at T1-4 (P＜0.05); And VAS scores were significantly lower at T1-6 in group S2 than those in group S3 (P＜0.05). Compared with group S1, Ramsay scores in group S2 and group S3 were significantly lower at T1-6 (P＜0.05); And Ramsay scores were significantly higher at T1-6 in group S2 than those in group S3 (P＜0.05). The incidence of bradyrhythmia and hypersomnia was significantly higher in group S1 than in group S2 and group S3 (P＜0.05). ConclusionIn patients undergoing thoracoscope surgery, dexmedetomidine 1 μg/(kg·d) combination with sufentanil 1 μg/(kg·d) for PCIA can achieve the better postoperative analgesic effects and the lower rate of bradyrhythmia and hypersomnia.