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目的 探讨右美托咪定联合舒芬太尼用于全麻低温体外循环下冠状动脉旁路移植术患者术后镇痛效果与不良反应.方法 前瞻性收集2016年8月至2017年2月在我院择期行全麻低温体外循环下冠状动脉旁路移植术患者120例.随机分为3组,舒芬太尼组(S组,n=40)、低剂量右美托咪定+舒芬太尼组(LD组,n=40)、高剂量右美托咪定+舒芬太尼组(HD组,n=40).S组:舒芬太尼1 ug/kg+盐酸托烷司琼注射液5mg加生理盐水稀释至100ml;SD组:右美托咪定2 ug/kg+舒芬太尼1 ug/kg+盐酸托烷司琼注射液5mg 加生理盐水稀释至100ml;HD组:右美托咪定4 ug/kg+舒芬太尼1 ug/kg+盐酸托烷司琼注射液5mg加生理盐水稀释至100ml.镇痛泵泵速2ml/h,PCA0.5ml,锁定时间15min.记录3组患者麻醉时间、手术时间、麻醉用药量、术后血管活性药物量、患者初次清醒时间、拔管时间.于拔管后6小时(T1)、12小时(T2)、24小时(T3)、36小时(T4)痛觉评分,采用视觉模拟评分法(visual analogue scale,VAS)、舒适度评分(bruggrmann comfort scale,BCS)和Ramsay镇静评分;记录患者不良反应,术后恶心呕吐(post-operative nausea and vomiting,PONV)视觉模拟评分.结果 三组患者术后VAS评分比较,在T2-T4点,S组VAS评分明显高于LD组和HD组,差异有统计学意义(P＜0.05),在T2和T4点LD组VAS评分明显高于HD组,差异有统计学意义(P＜0.05).BCS评分,在T2-T4点,HD组明显高于S组,差异有统计学意义(P＜0.05).Ramsay镇静评分,在T3点,LD组明显高于S组,差异有统计学意义(P＜0.05),在T2-T4点,HD组明显高于S组和LD组,差异有统计学意义(P＜0.05).PONV评分,在T3和T4点,S组显著高于LD组和HD组,差异有统计学意义(P＜0.05).结论 右美托咪定复合舒芬太尼应用于冠状动脉旁路移植术术后镇痛,能够增强镇痛、镇静效果,减少术后恶心、呕吐的发生率.高剂量右美托咪(4 ug/kg)泵人较低剂量右美托咪(2ug/kg)可能有更好的镇静、镇痛效果.“,”Objective To evaluate the postoperative analgesic efficacy and safety of dexmedetomidine combined with sulfentanyl for patient-controlled intravenous analgesia(PCIA) in patients after on pump coronary artery bypass grafting(CABG) in a randomized,doubleblind,placebo-controlled,prospective study.Methods One hundred and twenty patients were randomly divided into three groups:sulfentanyl group (group S,n=40),low dose dexmedetomidine group (group LD,n=40),high dose dexmedetomidine group(group HD,n=40).The formula for PCIA was as follow:Group S:sulfentanyl (1 ug/kg) + tropisetron hydrochloride 5mg in 100ml Normal saline(NS);Group LD:dexmedetomedine (2 ug/kg) + sulfentanyl (1 ug/kg) +tropisetron hydrochloride 5mg in 100ml NS;Group HD:dexmedetomedine (4 ug/kg ) +sulfentanyl(1ug/kg) +tropisetron hydrochloride 5mg in 100ml NS.The infusion rate was 2ml/h,bolus dose was 0.5ml in each group,and lockout time was 15 min.Pain level was assessed with visual analogue score(VAS),Bruggrmann comfort scale(BCS) and Ramsay sedation score.The scores and the adverse reaction were recorded at 6h(T1),12h(T2),24h(T3),36h(T4) during postoperative analgesia.Results The VAS scorings in Group S were significant higher than that in Group LD and Group HD at T2,T3,T4(P＜0.05),and the scorings in Group LD were higher than that in Group HD at T2 and T4.BCS scorings in Group HD displayed higher scores than that in Group S at T2,T3,T4(P＜0.05).The Ramsay scores in Group LD was higher than that in Group S at T3,and the scores in Group HD were much higher than Group S and Group LD at T2,T3,T4(P＜0.05).The PONV scores in Group S were higher than Group LD and Group HD at T3 and T4.Conclusion The combination of Dexmedetomidine and sulfentanyl could enhance the postoperative sedation and analgesia effect and reduce the PONV in patients undergoing on-pump coronary artery bypass grafting.High dose of dexmedetomidine might display more effective than low dose in sedation and analgesia.