右美托咪定对妇科手术麻醉诱导期舒芬太尼镇痛和镇静效果的影响  

The effects of dexmedetomidine on analgesia and sedation of sulfentanil in gynecological operation during anesthesia induction

作　　者：张昱昊 段光友[1] 张咸伟[1] 郭珊娜 英英[1] 黄鹏浩 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉市430030

出　　处：《临床麻醉学杂志》2015年第2期117-120,共4页Journal of Clinical Anesthesiology

摘　　要：目的借助压痛阈值测量和Narcotrend监测实时评价右美托咪定对妇科手术患者麻醉诱导期小剂量舒芬太尼镇痛和镇静效果的影响。方法全麻下择期行妇科手术患者100例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为右美托咪定组（D组）和对照组（C组）,每组50例。D组：静脉给予1μg/kg右美托咪定（稀释到10ml）＋0.4μg/kg舒芬太尼,C组：静脉给予10ml生理盐水＋0.4μg/kg舒芬太尼。记录给药前（T1）、给予右美托咪定或生理盐水后（T2）、患者达最高清醒程度（T3）和给予舒芬太尼5min后（T4）时的Nacotrend指数（NTI）,同时记录T3至T4期间NTI到达最低值的时间;并于T1和T4时测量探头压痛痛阈（pressure pain threshold,PPT）及耐痛阈（pressure pain tolerance,PTO）。结果与T1时比较,T2时两组NTI均明显下降（P〈0.05）,且D组明显低于C组（P〈0.05）。T3至T4期间,D组NTI达到最低值的时间明显快于C组（P〈0.01）。与T1时比较,T4时两组PPT及PTO均明显增高（P〈0.05）,且D组的增加幅度明显大于C组（P〈0.05或P〈0.01）。给予舒芬太尼后D组的RR明显慢于C组（P〈0.05）。结论右美托咪定可以增强小剂量舒芬太尼的镇痛效应,也可缩短镇静作用的起效时间,或存在增加舒芬太尼呼吸抑制的风险。Objective To evaluate the analgesic and sedative effect of preoperative dexmedeto- midine hydrochloride combined with sulfentanil by means of mechanical pain sensitivity measurement and Narcotrend. Methods A total of 100 patients, aged 18-65 years old, ASA I or lI, undergoing elective gynecological operations were randomly divided into two groups with 50 patients each： group D received dexmedetomidine 1/lg/kg （dilute to 10 ml） followed by sufentanil 0. 4μg/kg, group C re- ceived 0. 9% saline （10 ml） and sufentanil 0. 4/lg/kg NTI were observed before and after the first medication（T1 and T2 ）, patient awaken by calling before sufentanil （Ts） and 5 rain after sufentanil （T4）. The PPT and PTO were also recorded at T1 and T~. Results NTI of both groups decreased at T2 compared to T1 （P〈0.05）, and NTI of group D was less than that of group C（P〈0.05）. The time of NTI in group D declined was less than that in group C（P〈0. 01）. PPT and PTO of both groups increased at T4 compared to T1 （P〈0. 05）, and the increased values of group D were greater than that of group C（P〈0. 05）. RR of group D at T4 was less than that of group C （P〈0. 05）. Conclusion Dexmedetomidine can improve the analgesic effect of small-dose sufentanil in gynecologi- cal patients,and in some degree, can increase the risk of respiratory depression because of reduced effecting time of sedative of sufentanil.

关 键 词：右美托咪定 舒芬太尼 镇静 镇痛 痛阈 

分 类 号：R614[医药卫生—麻醉学]