目的 觀察不同劑量右美托咪定復(fù)合舒芬太尼對普外科術(shù)后自控靜脈鎮(zhèn)痛的效果。方法 選擇2010年3月-2013年4月于牡丹江醫(yī)學(xué)院紅旗醫(yī)院ASA分級為Ⅰ或Ⅱ級行普外科手術(shù)患者100例，隨機(jī)分為對照組和治療組低、中、高劑量組，各25例。4組均給予鹽酸格拉司瓊注射液5 mg，加入生理鹽水200 mL，入靜脈自控鎮(zhèn)痛泵。在此基礎(chǔ)上，對照組給予枸櫞酸舒芬太尼注射液0.04 μg/（kg·h），治療組低、中、高劑量組分別給予鹽酸右美托咪定注射液0.08、0.09、0.10 μg/（kg·h）+枸櫞酸舒芬太尼注射液0.02 μg/（kg·h）。記錄術(shù)后6、12、24、48 h各時間點(diǎn)的VAS評分、Ramsay評分，并比較各組的血壓、心率、呼吸變化、PCA按壓次數(shù)以及不良反應(yīng)。結(jié)果 術(shù)后6、12 h，治療組中、高劑量組VAS評分顯著低于對照組和治療組低劑量組，且差異具有統(tǒng)計學(xué)意義（P<0.05、0.01）。術(shù)后6 h，與對照組和治療組低劑量組相比，治療組中、高劑量組Ramsay評分均增高；術(shù)后12 h，治療組高劑量組的Ramsay評分顯著高于對照組（P<0.05）。與對照組相比，治療組低劑量組術(shù)后6 h，治療組中劑量組術(shù)后12、48 h，治療組高劑量組術(shù)后6、12、24 h收縮壓均有所降低，差異有統(tǒng)計學(xué)意義（P<0.05）；治療組低劑量組術(shù)后24 h，治療組中劑量組12、24、48 h，治療組高劑量組術(shù)后6、12、24 h舒張壓降低，差異有統(tǒng)計學(xué)意義（P<0.05）。治療組低劑量組術(shù)后6 h心率顯著降低（P<0.05）；治療組中、高劑量組術(shù)后6、12、48 h心率均不同程度降低，差異有統(tǒng)計學(xué)意義（P<0.05）。與對照組相比，治療組低、中、高劑量組呼吸率變化無統(tǒng)計學(xué)差異，均未出現(xiàn)呼吸抑制。治療組中、高劑量組術(shù)后的自控鎮(zhèn)痛次數(shù)明顯減少，差異具有統(tǒng)計學(xué)意義（P<0.05）。與對照組相比，治療組的不良反應(yīng)率明顯降低，差異具有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 中劑量的右美托咪定能夠明顯提高術(shù)后舒芬太尼自控靜脈鎮(zhèn)痛鎮(zhèn)靜效果，減少不良反應(yīng)。

Objective To observe the effect of dexmedetomidine with different doses combined with sufentanil in the treatment of self-control intravenous analgesia after general surgery. Methods Patients (100 cases) with ASA physical status I or II after general surgery in Hongqi Hospital of Mudanjiang Medical College from March 2010 to April 2013 were randomly divided into control, low-, mid-, and high-dose treatment groups (25 cases in each group). The patients in four groups were given 5 mg Granisetron Hydrochloride Injection, and 200 mL saline was added into the veins of self-control analgesia pump. On the basis, the patients in the control group was given 0.04 μg/(kg·h) Sufentanil Citrate Injection, the patients in the low-, mid-, and high-dose treatment groups were respectively given Dexmedetomidine Hydrochloride Injection 0.08, 0.09, and 0.10 μg/(kg·h) + Sufentanil Citrate Injection 0.02 μg/(kg·h). After 6, 12, 24, and 48 h of operation, VAS and Ramsay scores, blood pressure, heart rate, breathing, PCA press times, and adverse reactions of patients were recorded. Results After 6 and 12 h of operation, VAS scores of mid-and high-dose treatment groups were lower than those of control and low-dose treatment groups (P < 0.05, 0.01). After 6 h of operation, compared with control and low-dose treatment groups, Ramsay scores in the mid-and high-dose treatment groups increased significantly (P < 0.05). After 12 h of operation, Ramsay scores in the high-dose treatment group were higher than those in the control group after operation, with significant difference (P < 0.05). Compared with control group, SBP in low-dose treatment group 6 h after operation, in mid-dose treatment group 12 and 48 h after operation, and in high-dose treatment group 6, 12, and 24 h after operation decreased with significant difference (P < 0.05). DBP in low-dose group 24 h after operation, in mid-dose treatment group 12, 24, and 48 h after operation, and in high-dose treatment group 6, 12, and 24 h after operation decreased with significant difference (P < 0.05). Heart rate in low-dose treatment group 6 h after operation, in mid-and high-dose treatment groups 6, 12, and 48 h after operation decreased significantly (P < 0.05). Compared with control group, breathing rate change in the low-, mid-, and high-dose treatment group had no significant difference. After operation, self-control analgesia times decreased with significant difference (P < 0.05). Compared with control group, the adverse reaction rate in three groups decreased significantly (P < 0.05). Conclusion Dexmedetomidine[0.09 μg/(kg·h)] can make an obvious effect on the efficacy of self-controlled intravenous analgesia after general surgery, and decrease the incidence of adverse reaction.