右美托咪定在胸科术后镇痛复合舒芬太尼最佳剂量的选择.doc

右美托咪啶复合舒芬太尼用于胸科手术后自控静脉镇痛效果观察 作者单位：230061安徽医科大学第三附属医院麻醉科 通信作者：董春山，Email： dcs0018@163.com 【摘要】 目的 确定右美托咪啶复合舒芬太尼用于胸科手术后自控静脉镇痛（PCIA）的半数有效剂量（ED50）。方法 择期在全身麻醉下行开胸手术患者，性别不限，ASA分级I~II级，年龄32~65岁，患者采用静-吸复合全身麻醉。于手术结束时启用术后静脉自控镇痛（PCIA)，使用药物为舒芬太尼2.5μg/kg复合右美托咪啶，第1例患者右美托咪啶复合剂量为3μg/kg，采用改良序贯法的等差级剂量为0.5μg/kg。采用VAS评分、Ramsay镇静评分等综合评价镇痛镇静效果满意度。采用概率单位回归分析法计算镇痛镇静满意的ED50及95%可信区间(CI)。结果 入选患者35例，PCIA效果满意17例，效果不满意18例；术后48h内无镇静过度和呼吸抑制不良反应发生。右美托咪啶复合舒芬太尼PCIA效果满意的ED50为3.99μg/kg,95%CI为2.29~4.43μg/kg，相应的ED95为4.92μg/kg,95%CI为4.43~10.50μg/kg。结论 右美托咪啶复合舒芬太尼PCIA效果满意的ED50为3.99μg/kg。 【关键词】 右美托咪啶；舒芬太尼；胸科手术；术后；静脉自控镇痛；剂量效应关系 Median effective dose of dexmedetomidine combined with sufentanil for intravenous patient-controlled analgesia in thoracic surgery Dong Chun shan, Sun Peng, Zang Jun, Yu Jun ma. Department of Anesthesiology, Third affiliated hospital of Anhui Medical University，Hefei230061, China Corresponding author: DONG Chun-shan, Email: dcs0018@163.com 【Abstract】 Objective To determine the median effective dose of dexmedetomidine combined with sufentanil for intravenous patient-controlled analgesia in thoracic surgery. Methods Thirty-five ASA I -II patients of both sexes, aged 32-65 yr, scheduled for thoracic surgery under general anesthesia with intravenous combined with inhalation, were enrolled in this study. At end of surgery, patients were attached to a postoperative intravenous controlled analgesia machine, which was combined sufentanil 2.5 μg/kg and dexmedetomidine, the dose of dexmedetomidine was determined using the modified up-and-down method (0.5μg/kg as a step size). The first patient was tested at 3 μg/kg dexmedetomidine. Analgesic and sedation efficacy were assessed throughout the 48 h study period with 10-cm visual analog scales and 6-point Ramsay sedation scales. Probit analysis was used for calculating ED50, ED95 and 95% confidence interval (CI). Results The responses of 35 consecutive patients in whom receiving intravenous patient-controlled analgesia was assessed, and 17 pat