右美托咪定预先给药对术后疼痛及瑞芬太尼痛觉过敏的影响  

Effects of pretreatment with dexmedetomidine on postoperative pain and remifentanil-induced hyperalgesia

作　　者：陶佳[1,2] 顾小萍[3] 彭良玉[3] 张伟[3] 业光衡[3] 马正良[3] 

机构地区：[1]江苏省麻醉学重点实验室徐州医学院 [2]江苏省麻醉医学研究所,徐州市221002 [3]南京大学医学院附属鼓楼医院麻醉科

出　　处：《临床麻醉学杂志》2011年第10期947-949,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察术前静脉预注射右美托咪定对术后疼痛及大剂量瑞芬太尼麻醉痛觉过敏的影响。方法选择ASAⅠ或Ⅱ级择期行妇科腹腔镜手术的患者80例,随机分为小剂量右美托咪定组(L组)、中剂量右美托咪定组(M组)、大剂量右美托咪定组(H组)和对照组(C组),每组20例。L、M组和H组患者分别于诱导前静脉注射右美托咪定0.2、0.4和0.8μg/kg。C组患者静脉注射生理盐水。记录手术时间、苏醒时间、拔管后Ramsay评分,拔管后30 min、1、4、8、24 h VAS评分及恶心呕吐、寒颤等不良反应的发生情况。结果 L、M和H组拔管后VAS评分明显低于C组(P<0.05),且呈现剂量依赖性。L组改善VAS评分的作用一直持续到拔管后8 h,而M组和H组则持续了至少24 h。C组术后使用曲马多例数明显多于L、M和H组(P<0.05)。术后恶心呕吐发生率C组明显高于L、M和H组(P<0.05)。结论术前预注右美托咪定能明显改善患者的术后疼痛及大剂量瑞芬太尼麻醉所导致的痛觉过敏,并减少术后恶心呕吐的发生率。Objective To observe the effects of intravenous pretreatment with dexmedetomidine on postoperative pain and remifentanil-induced hyperalgesia in patients. Methods Eighty patients （ASA Ⅰ or Ⅱ） scheduled for gynecologic laparoscopic surgery were randomly divided into four groups （n = 20 in each group）： low-dose （group L）, middle-dose （group M）, high-dose （group H） group and control group （group C）. Before induction of anesthesia, patients in group L, M and H were given an intravenous infusion of 0. 2μg/kg, 0. 4μg/kg and 0. 8μg/kg dexmedetomidine, patients in group C were injected with saline, respectively. Surgery duration, extubation time, sedation score, the scores of VAS and the incidences of adverse effects were recorded. Results The VAS scores of group L, group M and group H were significantly lower than that of group C （P〈0. 05） after surgery and the effect of dexmedetomidine on VAS was dose-dependent. The improving effect of dexmedetomidine on postoperative analgesia in group L continued to 8 h, and in group M and H continued to 24 h after operation. The administration additional narcotic analgesics were higher in group C than that in the other three groups in the postoperative period of 24 h. In addition, pretreatment with dexmedetomidine also decreased the incidences of postoperative nausea and vomiting. Conclusion Pretreatment with dexmedetomidine improved postoperative analgesia and alleviated remifentanil-induced postoperative hyperalgesia. Dexmedetomidine also decreased the incidence of postoperative nausea and vomiting.

关 键 词：右美托咪定 瑞芬太尼 痛觉过敏 腹腔镜手术 

分 类 号：R614[医药卫生—麻醉学]