Clinical Application Of Dexmedetomidine With Different Doses Of Sufentanil For Patient Controlled Intravenous Analgesia After Hip Replacement

Objective:To compare the efficacy of dexmedetomidine combine with three different doses of sufentanil in the elderly patients after hip replacement.Methods:130 patients（age 62-87,height 150-175cm,weight 50-78kg,gender unlimited,ASA II-III）who underwent PCIA after selective total hip arthroplasty in our hospital from January 2018 to January 2019 were divided into groups a,B and C according to the random number table.Three different doses of sufentanil,0.5μg/kg in group A（n=41）,0.75μg/kg in group B（n=44）,and 1.0μg/kg in group C（n=45）,combine with1.5μg/kg dexmedetomidine were used for PCIA.PCIA was diluted to 100mL with0.9%normal saline,the background infusion speed was 2mL/h,the locking time was15min,and the self-control dose was 0.5mL/time until 48h after operation.Respiratory and circulatory indexes,respiratory rate（RR）,pulse oxygen saturation（SpO2）,heart rate（HR）and mean arterial pressure（map）,analgesia degree（NRS）,sedation degree（improved OAA/s）,T₃ joint score（Harris）were recorded before operation（T0）,6h（T1）,12h（T2）,24h（T₃）,48h（T₄）.The total times of PCIA compression,the times of tramadol use and the occurrence of side effects（respiratory depression,hypotension,bradycardia,nausea/vomiting,pruritus and delirium）were recorded within 48 hours after operation。Results:There was no significant differences in age,gender,BMI,ASA classification,operation time,anesthesia time,bleeding volume and total sufentanil among the three groups;HR,RR and SpO2 in group C were statistically significant compared with those in group A（P<0.05）;NRS score in group C was significantly lower than that in group A and B（P>0.05）The improved OAA/s score was significantly higher than that of group A and B（P<0.05）;Pressure times of PCIA and dosage of tramadol in group A were higher than that of other groups（P<0.05）;the incidence of adverse reactions in group C was significantly higher than that in groups A and B（P<0.05）.Conclusion:The patient-controlled intravenous analgesia after hip joint operation in middle-aged and old patients can have good analgesic and sedative effects.The PCIA with 1.5μg/kg dexmedetomidine and 0.75μg/kg sufentanil was more effective,with stable postoperative vital signs,good postoperative recovery and low incidence of side effects.