目的：观察右美托咪定联合舒芬太尼在肺叶切除手术患者，进行术后48小时静脉自控镇痛中的应用效果。方法：80例患者采用随机数字表法分为对照组和观察组：对照组 (A组) 采用舒芬太尼0.04μg•kg-1•h-1经静脉微量泵泵注，观察组（B组） 采用舒芬太尼0.03μg•kg-1•h-1 +盐酸右美托咪定0.07μg•kg-1•h-1泵注，术后即刻行患者静脉自控镇痛。观察病人术前和PCIA开始镇痛后1h、6h、12h、24h、48h时刻的生命指标，及术后对应时间点VAS评分、Ramsay镇静评分、自控镇痛按压人数和不良反应发生率，做统计学分析。结果：A组、B组均能达到目标镇痛水平，各时间点VAS评分均<4分，与A组相比B组在术后6h、12hVAS两个时间点评分降低，差异有统计学意义(P<0. 05)。B组在术后6 h、12h两个时间点Ramsay评分增高(P<0.05) ，均未出现镇静过度，Ramsay评分<4分，B组术后l-48h血流动力学更加平稳，不良反应发生率明显降低(P<0.05) 。结论：0.07μg•kg•h盐酸右美托咪定可明显提高舒芬太尼在肺叶切除患者术后静脉自控镇痛、镇静效果，并减少其用量从而减少相关不良反应，且能维持血液动力学稳定。
OBJECTIVE: To observe the effect of patient-controlled intravenous analgesia (PCIA)with Dexmedetomidine-sufentanil after pulmonary lobectomy within 48 hours. METHODS: A total of 80 patients were enrolled in this study. PCIA was set immediately after operation in group A (sufentanil 0.04μg•kg-1•h-1，n= 40) and group B (suifentanil 0.03μg•kg-1•h-1 +Dexmedetomidine 0.07μg•kg-1•h-1，n=40). Postoperative VAS score, Ramsay score, pressing times and other adverse events at the 1h、6h、12h、24h、48h were recorded and analyzed. RESULTS: Both of the two groups were effective in pain relief.VAS scores were reduced at 6 and 12 h after operation and the Ramsay score was higher in group B(P<0.05). CONCLUSION: Dexmedetomidine combining with sufentanil is a complement drug for sufentanil in PCIA. Considering the side effects and overall satisfaction index, 0.07μg•kg-1•h-1 seems to be an ideal dosage for Dexmedetomidine using in the postoperative PCIA.
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