右美托咪啶对原发性高血压病人术后舒芬太尼自控静脉镇痛效果的影响

目的 探讨右美托咪啶对原发性高血压病人术后舒芬太尼自控静脉镇痛效果的影响.方法 择期拟行经腹子宫全切术的原发性高血压病人60例,年龄42～63岁,体重48～72 kG,高血压分级Ⅰ或Ⅱ级,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将病人随机分为3组(n=20):对照组(C组)、不同剂量右美托咪啶组(D1组和D2组).术后24 h内行舒芬太尼PCIA,舒芬太尼100μg+托烷司琼5 mg+生理盐水100ml,背景输注速率2 ml/h,PCIA剂量0.5ml,锁定时间15 min.D1组和D2组在PCIA同时分别以0.2和0.3μg·kg-1·h-1的速率静脉输注右美托咪啶,C组在PCIA同时以0.1 ml·kg-1 的速率静脉输注生理盐水.术后24h内记录总按压次数、舒芬太尼用量和硝苯地平、麻黄碱的使用情况及呼吸抑制和呕吐的发生情况,术后24h时行Ramsay镇静评分.结果 与C组比较,D1组和D2组PCIA总按压次数减少,舒芬太尼用量降低,Ramsay镇静评分升高,硝苯地平使用率、呼吸抑制和呕吐发生率降低,D2组麻黄碱使用率升高(P＜0.05);与D1组比较,D2组PCIA总按压次数减少,舒芬太尼用量降低,Ramsay镇静评分升高,麻黄碱使用率升高(P＜0.05).结论 右美托咪啶不仅可减少原发性高血压病人术后舒芬太尼PCIA的用量,还可预防术后高血压进一步恶化.

Abstract：

Objective To investigate the effect of dexmedetomidine on postoperative patient-controlled intravenous analgesia (PCIA) with sufentanil in patients with essential hypertension. Methods Sixty ASA Ⅱ or Ⅲ patients with essential hypertension aged 42-63 yr weighing 48-72 kg undergoing hysterectomy were randomly divided into 3 groups ( n = 20 each): control group ( group C) and different doses of dexrmedetomidine groups ( group D1.2 ). PCIA was performed with sufentanil 1 μg/ml + tropisetron 5 μg/ml in 100 ml of normal saline within 24 h after operation (background infusion at 2 ml/h with a bolus dose of 0.5 ml and a 15 min lockout interval). Dexmein group C. Ramsay score was recorded. The number of attempts, consumption of sufentanil, the number of patients who needed nifedipine or ephedrine and side effects such as vomiting and respiratory depression were recoded within 24 h after operation. The level of sedation was evaluated with Ramsay sedation score at 24 h after operation.Results Compared with group C, the number of attempts, consumption of sufentanil, the number of patients who needed nifedipine and incidences of vomiting and respiratory depression were significantly decreased, while Ramsay score was significantly increased in D1 and D2 groups, and the number of patients who needed ephedrine was significanlly increased in group D2 ( P ＜ 0.05). The number of attempts and consumption of sufentanil were significantly decreased, and Ramsay score and the number of patients who needed ephedrine were significantly increased in group D2 compared with group D1 ( P ＜ 0.05). Conclusion Dexmedetomidine can not only reduce the consumption of sufentanil for postoperative PCIA, but also prevent postoperative hypertension from deteriorating in patients with essential hypertension.

Effect of dexmedetomidine on patient-controlled intravenous analgesia with sufentanil in patients with essential hypertension

Objective To investigate the effect of dexmedetomidine on postoperative patient-controlled intravenous analgesia (PCIA) with sufentanil in patients with essential hypertension. Methods Sixty ASA Ⅱ or Ⅲ patients with essential hypertension aged 42-63 yr weighing 48-72 kg undergoing hysterectomy were randomly divided into 3 groups ( n = 20 each): control group ( group C) and different doses of dexrmedetomidine groups ( group D1.2 ). PCIA was performed with sufentanil 1 μg/ml + tropisetron 5 μg/ml in 100 ml of normal saline within 24 h after operation (background infusion at 2 ml/h with a bolus dose of 0.5 ml and a 15 min lockout interval). Dexmein group C. Ramsay score was recorded. The number of attempts, consumption of sufentanil, the number of patients who needed nifedipine or ephedrine and side effects such as vomiting and respiratory depression were recoded within 24 h after operation. The level of sedation was evaluated with Ramsay sedation score at 24 h after operation.Results Compared with group C, the number of attempts, consumption of sufentanil, the number of patients who needed nifedipine and incidences of vomiting and respiratory depression were significantly decreased, while Ramsay score was significantly increased in D1 and D2 groups, and the number of patients who needed ephedrine was significanlly increased in group D2 ( P ＜ 0.05). The number of attempts and consumption of sufentanil were significantly decreased, and Ramsay score and the number of patients who needed ephedrine were significantly increased in group D2 compared with group D1 ( P ＜ 0.05). Conclusion Dexmedetomidine can not only reduce the consumption of sufentanil for postoperative PCIA, but also prevent postoperative hypertension from deteriorating in patients with essential hypertension.