标题：不同剂量右美托咪啶联合舒芬太尼自控镇痛对老年上腹部手术患者术后的镇痛及谵妄的影响

      作者：蔡吓锋，张良振，陈海    莆田市第一医院麻醉科，福建 莆田 351100

      卷次： 2020年31卷22期

      【摘要】 目的 探讨不同剂量右美托咪啶联合舒芬太尼自控镇痛对老年上腹部手术患者术后的镇痛及谵妄的影响。方法 选择2018年10月至2019年10月莆田市第一医院收治的80例行上腹部手术患者进行前瞻性研究，术后均给予静脉自控镇痛。80例患者根据随机数表法分为四组各20例，A组采用舒芬太尼2 μg/kg，B组采用右美托咪定1 μg/kg+舒芬太尼2 μg/kg，C组采用右美托咪定1.5 μg/kg+舒芬太尼2 μg/kg，D组右美托咪定2 μg/kg +舒芬太尼2 μg/kg。在患者苏醒后的4 h (T0)、8 h (T 1)、16 h (T 2)、24 h (T 3)、48 h (T4)时，比较四组患者的Ramsay评分和疼痛感视觉模拟量表(VAS)和术后谵妄发生率，同时比较术后追加阿片类镇痛剂比例和不良反应发生率。结果 C组和D组患者T1~T4时VAS评分明显低于B组和A组，差异均有统计学意义(P<0.05)；D组患者T0~T2、C组患者T1~T2时的Ramsay评分明显高于A组和B组，差异均有统计学意义(P<0.05)；C组和D组患者T2~T4时的谵妄发生率为0，明显低于A组的25.0%、20.0%、15.0%和B组的15.0%、15.0%、10.0%，差异均有统计学意义(P<0.05)；C组和D组患者T0~T4时的VAS评分、Ramsay评分、谵妄发生率比较差异均无统计学意义(P>0.05)；D组患者术后追加阿片类镇痛剂比例明显低于A组，C组和D组患者术后按压镇痛泵次数明显少于B组和A组，差异均有统计学意义(P<0.05)；A组、B组和C组患者的明显总不良反应发生率低于D组，差异有统计学意义(P<0.05)。结论 右美托咪定1.5 μg/kg +舒芬太尼2 μg/kg镇痛镇静效果好，术后谵妄发生率低，且安全性高，更适合老年患者上腹部手术术后镇痛。
      【关键词】 上腹部手术；右美托咪啶；舒芬太尼；自控镇痛；谵妄
      【中图分类号】 R656 【文献标识码】 A 【文章编号】 1003—6350（2020）22—2939—04

Effects of different doses of dexmedetomidine combined with sufentanil on postoperative analgesia and deliriumin elderly patients undergoing upper abdominal surgery.
CAI Xia-feng, ZHANG Liang-zhen, CHEN Hai. Departmentof Anesthesiology, Putian First Hospital, Putian 351100, Fujian, CHINA
【Abstract】 Objective To investigate the effect of different doses of dexmedetomidine and sufentanil on postop-erative analgesia and delirium in elderly patients undergoing upper abdominal surgery. Methods A total of 80 patientswith epigastric operation, who admitted to Putian First Hospital from October 2018 to October 2019, were studied pro-spectively, and were divided into four groups according to random number table: group A (20 cases, sufentanil 2 μg/kg),group B (20 cases, dexmedetomidine 1 μg/kg+sufentanil 2 μg/kg), group C (20 cases, dexmedetomidine 1.5 μg/kg+sufent-anil 2 μg/kg), group D (20 cases, dexmedetomidine 2 μg/kg+sufentanil 2 μg/kg). The Ramsay scores, visual analog scale(VAS) score, incidence of postoperative delirium, opioid analgesics, and adverse reactions were observed in the fourgroups at 4 h (T0), 8 h (T1), 16 h (T2), 24 h (T3) and 48 h (T4) after the patients regained consciousness. Results TheVAS scores at T1, T2, T3, T4 in group C and D were significantly lower than those of group B and group A (P<0.05); theRamsay scores at T0, T2 in group D and at T1, 2 in group C were significantly higher than those of group A and group B(P<0.05); the delirium incidence of T2, T3, T4 in group C and group D was all 0, which was significantly lower than cor-responding 25.0%, 20.0%, 15.0% of group A and corresponding 15.0%, 15.0%, 10.0% of group B (P<0.05); there wasno difference between the two groups in the VAS, Ramsay score, and incidence of delirium at T0, T1, T2, T3, T4 ingroup C and group D (P>0.05). The proportion of additional opioid analgesics in group D was significantly lower thanthat in group A, and the times of pressing analgesia pump in group C and group D were significantly lower than that ingroup B and group A (P<0.05). The total incidence of adverse reactions in group A, B and C was significantly lower thanthat in group D (P<0.05). Conclusion Dexmedetomidine 1.5 μg/kg+sufentanil 2 μg/kg has a good analgesic and seda-tive effect, a low incidence of postoperative delirium, and a high safety. It is more suitable for elderly patients with post-operative analgesia after upper abdominal surgery.
      【Key words】 Upper abdominal surgery; Dexmedetomidine; Sufentanil; Patient controlled analgesia; Delirium