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目的：观察气管内全身麻醉下行全髋置换术患者，术中静脉应用不同剂量右美托咪定对术后芬太尼静脉自控镇痛效果的影响及相关不良反应发生的情况。方法：选择择期在气管内全麻下行全髋置换术的患者60 例，ASA I ～Ⅱ级，年龄47～78 岁，体重 42～79 kg。患者随机分组法分为3 组(n=20)：C 组（盐水对照组）、D1 组（右美托咪定0.5 滋g/kg 组）和D2 组（右美托咪定1 ug/kg 组），在手术结束前约1 小时按分组分别给予生理盐水和右美托咪啶，术后镇痛使用芬太尼静脉自控镇痛24 h。记录患者术后2h、2~6 h、6~12 h、12~24 h芬太尼的用量；VAS 评分法评估患者术前、术后2 h、6 h、12 h、24 h 时的疼痛程度；记录镇痛期间恶心呕吐、皮肤瘙痒及过度镇静等不良反应发生的情况。结果：术后2h 和术后2~6 h芬太尼用量D1组和D2 组较C 组减少（P＜0.05），但D1组和D2 组之间比较无差异（P＞0.05）；而术后6~12 和12~24 h三组患者芬太尼用量无差异（P＞0.05）。术后2 h、2~6 hVAS 评分D1 组和D2 组较C组减少（P＜0.05），而D1组和D2 组之间比较无差异（P＞0.05）；术后6~12、12~24 h三组患者VAS 评分无差异（P＞0.05）。与C 组比较，D1 组和D2 组镇痛期间恶心呕吐发生率降低（P＜0.05），余不良反应各组之间比较无差异（P＞0.05）。结论：气管内全身麻醉下行全髋置换术的患者，术中静脉应用右美托咪啶可在术后6 h内增强芬太尼镇痛的效果减少芬太尼的用量，但增大剂量效果并不增加而作用时间也不延长。

英文摘要:

Objective:To observe the effects of different doses of intravenous dexmedetomidine on postoperative fentanyl patient-controlled analgesia of patients undergoing the total hip replacement with endotracheal general anesthesia.Methods:60 patients undergoing total hip replacement, ASA I - II, aged 47 to 78 y, weight 42 ~ 79 kg, were divided randomly into three groups (n=20): group C (saline group), group D1 (dexmedetomidine group of 0.5 ug/kg) and group D2 (dex medetomidine group of 1 滋g/kg), at 1 hour before the end of operation, groups were given saline and dexmedetomidine. The fentanyl patient-controlled intravenous analgesia were used for postoperative analgesia for 24 h. Record the fentanyl comsumption for 2 h, 2~6 h, 6~12 h, 12~24 h; The VAS score was used to assess patients' pain at 2 h, 6 h, 12 h, 24 h postoperative; Record the nausea and vomiting, skin itching and excessive sedation during the analgesia.Results:The fentanyl comsumption 2 h and 2~6 h postoperatively in group D1 and group D2 was less than that in group C (P<0.05), but there was no difference between group D1 and group D2 (P>0.05); there was no difference in analgesia fentanyl comsumption in 6~12 h or 12~24 h postoperatively (P>0.05). The VAS score of postoperative 2 h and 2~6 h in group D1 and group D2 were decreased when compared with group C (P<0.05), and between group D1 and group D2, there was no difference (P>0.05); the VAS score of the three groups in postoperative 6~12 h and 12~24 h, presented no difference (P>0.05). Compared with group C, the incidence of nausea and vomiting in group D1 and group D2 was decreased (P < 0.05), the other adverse reaction has no difference between every two groups (P>0.05).Conclusion:For the total hip replacement patients undergoing the endotracheal general anesthesia,intraoperative intravenous dexmedetomidine can enhance the analgesic effect of fentanyl and reduce the fentanyl comsumption during the first 6 hours postoperatively, but increase in the dose of dexmedetomiding can not promote the effect or prolong the effective time.

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