右美托咪啶对功能性鼻内镜鼻窦手术后曲马多镇痛质量的影响  

Influence of Dexmedetomidine on analgesic quality of Tramadol after functional endoscopic sinus surgery

作　　者：丁登峰[1] 王琦[1] 罗耀文[1] 张雪萍[1] 李亚丽[1] 

机构地区：[1]暨南大学第二临床医学院附属深圳市人民医院麻醉科,广东深圳518020

出　　处：《中国现代医学杂志》2014年第29期72-75,共4页China Journal of Modern Medicine

摘　　要：目的观察右美托咪啶对功能性鼻内镜鼻窦手术（FESS）术后曲马多镇痛质量的影响。方法择期行FESS患者80例,随机分为D0、D1、D2、D3 4组,每组20例,采用丙泊酚与瑞芬太尼TCI气管插管全身麻醉。D1、D2、D3组麻醉诱导前15 min,静脉输注右美托咪啶0.6μg/kg后分别以0.3、0.6、0.9μg/（kg h）维持至手术结束,D0组静脉输注等剂量生理盐水。记录手术时间、拔管时间及丙泊酚、瑞芬太尼总用量,采用视觉模拟评分（VAS）对患者术后2、4、8和12 h疼痛进行评分,观察术中心动过缓、低血压及术后低氧血症、恶心、呕吐等不良反应发生率,记录术后使用哌替啶患者例数。结果 D0、D1组丙泊酚和瑞芬太尼用量多于D2、D3组（P〈0.05）,术后2、4和8 h VAS数值D1-D3组低于D0组（P〈0.05）,D2-D3组低于D1组（P〈0.05）,D0和D1组术后低氧血症、恶心发生率及术后使用哌替啶患者例数高于D2、D3组（P〈0.05）。结论右美托咪啶用于FESS,可改善曲马多的镇痛效果,减少麻醉药用量。【Objective】 To observe the influence of Dexmedetomidine on analgesic quality of tramadol after functional endoscopic sinus surgery（FESS）. 【Methods】 Eighty patients scheduled to undergo FESS were randomly assigned to four groups（D0, D1, D2 and D3 group） with 20 each. All patients were given general anesthesia with target-controlled infusion of Propofol and Remifentanil. D1, D2, D3 group received intravenous0.3, 0.6, 0.9 μg/（kg·h） Dexmedetomidine respectively after 0.6μg·kg bolus within 15 minutes. D0 group received the same dose saline. The operation time, extubation time and consumption of Propofol and Remifentanil were recorded. Postoperative pain was assessed by visual analogue score（VAS） at 2 h, 4 h, 8 h, 12 h after operation. The incident of intra-operative bradycardia and hypotension, postoperative hypoxemia, nausea,vomiting and case of using Pethidine were also observed. 【Results】 The consumption of Propofol and Remifentanil in D0, D1 group was more than that in D2, D3 group（P〈0.05）. The VAS was lower at 2 h, 4h, 8 h, 12 h after operation in D1, D2, D3 group than D0 group（P〈0.05） and D2, D3 group than D1 group（P〈0.05）. The incident of hyoxemia, nausea and case of using Pethidine were higher in D0, D1 group（P〈0.05）. 【Conclusion】 Dexmedetomidine can improve the analgesic quality of tramadol and reduce the consumption of Propofol and Remifentanil after FESS.

关 键 词：右美托咪啶 功能性鼻内镜鼻窦手术 曲马多 靶控输注 

分 类 号：R614.24[医药卫生—麻醉学]