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,0.5?g/kg in group A?n=41?,0.75?g/kg in group B?n=44?,and 1.0?g/kg in group C?n=45?,combine with1.5?g/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 1.5?g/kg dexmedetomidine and 0.75?g/kg sufentanil was more effective,with stable postoperative vital signs,good postoperative recovery and low incidence of side effects.