Objective To evaluate the efficacy of different doses of Dexmedetomidine (Dex) combined with Sufentanil for patient-controlled intravenous analgesia after spinal surgery.Methods 120 cases of patients with ASA Ⅰ-Ⅲ grade underwent elective spinal surgery with general anesthesia in Luzhou Traditional Chinese Medicine Hospital from January 2015 to December 2016 were selected,and randomly divided into group A,group B and group C,each gorup had 40 cases.The postoperative intravenous analgesia formula:Sufentanil 0.05 μg/(kg·h) in group A,Sufentanil 0.03 μg/ (kg·h) + Dex 0.05 μg/(kg·h) in group B,and Sufentanil 0.03 μg/(kg·h) + Dex 0.08 μg/(kg·h) in group C,and all added to normal saline to 100 mL,loading dose of 3 mL,background dose of 2 mL/h,PCA dose of 1 mL and locking time of 15 min.The VAS and Ramsay scores at the time points of 2,4,6,12,24 h after surgery,PCIA pressing times,the dosages of Sufentanil and complications such as nausea and vomiting,hypotension,bradycardia,respiratory depression in the three groups were recorded.Results The VAS and Ramsay scores at different time points in the three groups were tatistically significant differences (P ＜ 0.01).Compared with group A,the VAS scores at the time points of 4,6,12,24 h after surgery in group B and group C were decreased (P ＜ 0.01),and the VAS scores of group C were lower than those of group B (P ＜ 0.05).Compared with group A,the Ramsay scores at the time points of 4,6,12,24 h in group B and group C were increased (P ＜ 0.05),and the Ramsay scores of group C were higher than those of group B (P ＜ 0.05).The PCA pressing times and the dosage of Sufentanil of group B and group C were less than those of group A (P ＜ 0.01),which of group C were less than those of group B (P ＜ 0.01).The incidence of nausea and vomiting of group A was significantly higher than that of group B and group C (P ＜ 0.05).Conclusion Dex combined with Sufentanil for patient-controlled intravenous analgesia after spinal surgery has good effects,and Dex can enhance the analgesic effect and reduce dosage and adverse reaction of opioids.%目的 评价不同剂量右美托咪啶复合舒芬太尼用于脊柱手术后静脉自控镇痛的效果.方法 选择四川省泸州市中医医院2015年1月～2016年12月拟全身麻醉下行脊柱手术的患者120例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,采用数字随机表法分为A、B、C组,每组各40例.术毕静脉自控镇痛液配方:A组给予舒芬太尼0.05μg/(kg·h);B组给予舒芬太尼0.03μg/(kg·h)+右美托咪啶0.05 μg/(kg·h);C组给予舒芬太尼0.03 μg/(kg·h)+右美托咪啶0.08 μg/(kg·h),均加生理盐水至100 mL.负荷剂量3 mL,背景剂量2 mL/h,PCA剂量1 mL,锁定时间15 min.记录三组患者术后2、4、6、12、24 h时间点的VAS、Ramsay评分、PCIA按压次数、舒芬太尼的药物总量以及恶心、呕吐、低血压、心动过缓、呼吸抑制等并发症的发生情况.结果 A、B、C组在术后不同时间点VAS和Ramsay评分差异有高度统计学意义(P＜0.01);与A组比较,B、C组VAS评分在术后4、6、12、24h降低(P＜0.01),且C组VAS评分低于B组(P＜0.05);与A组比较,B、C组Ramsay评分在术后4、6、12、24h时间点升高(P＜0.05),且C组Ramsay评分高于B组(P＜0.05).与A组比较,B、C组PCIA按压次数减少(P＜0.01),舒芬太尼用量减少(P＜0.01),且C组PCIA按压次数和舒芬太尼用量少于B组(P＜0.01).A组恶心呕吐发生率明显高于B组和C组(P＜0.05).结论 右美托咪啶复合舒芬太尼用于脊柱手术后静脉自控镇痛效果好,右美托咪啶可增强阿片类药物的镇痛效果,并减少阿片类药物的用量和不良反应.
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