目的 观察不同剂量右美托咪定复合舒芬太尼对普外科术后自控静脉镇痛的效果。方法 选择2010年3月-2013年4月于牡丹江医学院红旗医院ASA分级为Ⅰ或Ⅱ级行普外科手术患者100例，随机分为对照组和治疗组低、中、高剂量组，各25例。4组均给予盐酸格拉司琼注射液5 mg，加入生理盐水200 mL，入静脉自控镇痛泵。在此基础上，对照组给予枸橼酸舒芬太尼注射液0.04 μg/（kg·h），治疗组低、中、高剂量组分别给予盐酸右美托咪定注射液0.08、0.09、0.10 μg/（kg·h）+枸橼酸舒芬太尼注射液0.02 μg/（kg·h）。记录术后6、12、24、48 h各时间点的VAS评分、Ramsay评分，并比较各组的血压、心率、呼吸变化、PCA按压次数以及不良反应。结果 术后6、12 h，治疗组中、高剂量组VAS评分显著低于对照组和治疗组低剂量组，且差异具有统计学意义（P<0.05、0.01）。术后6 h，与对照组和治疗组低剂量组相比，治疗组中、高剂量组Ramsay评分均增高；术后12 h，治疗组高剂量组的Ramsay评分显著高于对照组（P<0.05）。与对照组相比，治疗组低剂量组术后6 h，治疗组中剂量组术后12、48 h，治疗组高剂量组术后6、12、24 h收缩压均有所降低，差异有统计学意义（P<0.05）；治疗组低剂量组术后24 h，治疗组中剂量组12、24、48 h，治疗组高剂量组术后6、12、24 h舒张压降低，差异有统计学意义（P<0.05）。治疗组低剂量组术后6 h心率显著降低（P<0.05）；治疗组中、高剂量组术后6、12、48 h心率均不同程度降低，差异有统计学意义（P<0.05）。与对照组相比，治疗组低、中、高剂量组呼吸率变化无统计学差异，均未出现呼吸抑制。治疗组中、高剂量组术后的自控镇痛次数明显减少，差异具有统计学意义（P<0.05）。与对照组相比，治疗组的不良反应率明显降低，差异具有统计学意义（P<0.05）。结论 中剂量的右美托咪定能够明显提高术后舒芬太尼自控静脉镇痛镇静效果，减少不良反应。

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.