右美托咪定对术后吗啡自控镇痛效果的影响  

The effect of dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine

作　　者：斯妍娜[1] 韩流[1] 王晓亮[1] 王宏宇[1] 苏中宏[1] 鲍红光[1] 

机构地区：[1]南京医科大学附属南京第一医院麻醉科,210006

出　　处：《临床麻醉学杂志》2011年第10期953-955,共3页Journal of Clinical Anesthesiology

基　　金：南京市科技局医学重点科技发展项目(2KX07001);南京医科大学科技发展基金项目(2010NJMU052)

摘　　要：目的探讨右美托咪定(Dex)对术后吗啡自控镇痛患者疼痛的影响。方法择期全麻手术患者40例,ASAⅠ或Ⅱ级,随机均分为两组,分别在手术结束前30 min缓慢静注(10 min)Dex0.8μg/kg(Dex组)和对照组(C组)。患者进入麻醉后恢复室静脉缓慢推注吗啡0.05 mg/kg作为负荷量,之后接镇痛泵行PCIA,设定吗啡bolus剂量0.02 mg/kg。记录PCIA开始后1、2、6、12和24 h的VAS、Ramsay镇静评分(RSS)和吗啡累积消耗量;记录术后24 h内恶心、呕吐和寒战等发生情况。结果 PCIA后各时点两组VAS评分和RSS差异无统计学意义。Dex组吗啡累积消耗量明显少于C组(P<0.05或P<0.01)。Dex组术后24 h内恶心、呕吐和寒战的发生率明显低于C组(P<0.05)。结论手术结束前30 min缓慢静注(10 min)0.8μg/kg Dex可显著降低术后吗啡用量,并降低术后恶心、呕吐和寒战等不良反应发生率。Objective To investigate the effect of dexmedetomidine （Dex） on postoperative pain in patients receiving patient-controlled morphine. Methods Forty patients （ASA Ⅰ or Ⅱ ） undergoing selective operation were randomly divided into 2 groups： Dex group （group Dex, n= 20） and control group （group C,n= 20）. Patients in Dex group were received （0.8 μg/kg） Dex and control group were received normal saline respectively by pumped infusion 30 minutes before the operation finished. All patients received a standardized （0.05 mg/kg） loading dose of morphine in postanesthesia care unit （PACU）. Then they were allowed to use a patient-controlled infusion analgesia （PCIA） device giving bolus doses of morphine （0.02 mg/kg）. VAS score, Ramsay sedation scale （RSS） and cumulative morphine consumption were recorded at 1, 2, 6, 12 and 24 h after the beginning of PCIA. The incidence of postoperative nausea, vomiting and shivering was recorded. Results Compared with group C, cumulative morphine consumption in group Dex was obviously decreased（P〈0.05 or P〈 0.01） ; the incidence of early （up to 24 h） postoperative nausea, vomiting and shivering in Dex group were significantly decreased （P 〈 0.05）. Conclusion Dexmedetomidine with a single dose of 0.8 μg/kg （given 10 min by pumped infusion） 30 min before operation finished can significantly reduce postoperative morphine consumption and the incidence of postoperative nausea, vomiting and shivering.

关 键 词：右美托咪定 吗啡 术后镇痛 术后恶心呕吐 寒战 

分 类 号：R614[医药卫生—麻醉学]