右美托咪定在脊柱后路手术中对瑞芬太尼麻醉术后痛觉过敏的影响  

Comparison of Edobutton joint Intrafix and absorbable interference screw fixation in anterior cruciate Hgament reconstruction using hamstring autograft

作　　者：金鑫[1] 夏长所[1] 肖程程 张才龙[1] 

机构地区：[1]安徽医科大学附属省立医院麻醉科,合肥230001

出　　处：《中华临床医师杂志（电子版）》2015年第8期9-13,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的：观察右美托咪定在脊柱后路手术中对瑞芬太尼麻醉术后痛觉过敏的影响。方法择期行脊柱后路手术的患者60例，采用随机数字表法，将患者随机分成两组，每组30例。D组在麻醉诱导前开始静脉输注右美托咪定0.6μg/kg，15 min后减量至0.2μg＆#183;kg-1＆#183;h-1，手术结束前15 min停药；C组输注等容量生理盐水。两组患者术中瑞芬太尼输注速率均为0.3μg＆#183;kg-1＆#183;min-1，复合丙泊酚维持麻醉。术毕所有患者均行PCIA。记录手术时间，术中丙泊酚、瑞芬太尼的用量，麻醉前（T0）、术后4 h（T1）、术后12 h（T2）、术后24 h（T3）、术后48 h（T4）的血浆皮质醇浓度及皮肤机械痛阈值，T1、T2、T3、T4时点的VAS评分，术后首次PCIA按压时间，术后48 h PCIA按压次数、舒芬太尼用量、追加曲马朵的例数。结果两组患者手术时间，术中瑞芬太尼用量均无统计学差异（P＞0.05）；术中丙泊酚的用量D组少于C组（P＜0.05）；T1、T2时与D组比较，C组患者皮肤机械痛阈值降低，血浆皮质醇浓度增高（P＜0.05）；T1时与D组比较，C组VAS评分增高（P＜0.05）；与D组比较，C组术后首次PCIA按压时间缩短，术后48 h PCIA按压次数增多、舒芬太尼用量增多、追加曲马朵的例数增多（P＜0.05）。结论右美托咪定在脊柱后路手术中可有效预防瑞芬太尼麻醉术后的痛觉过敏，减少麻醉药用量，可能与减少应激反应有关。Objective To observe the effects of intravenous dexmedetomidine on remifentanil-induced hyperalgesia in posterior spine surgery. Methods Sixty patients scheduled for posterior spine surgery were randomly divided into two groups randomly （n=30 in each group）. Before induction of anesthesia, patients in group D were given an intravenous infusion of 0.6μg/kg dexmedetomidine, reducing to 0.2μg＆#183;kg-1＆#183;h-1 after 15 min, and stop it 15 min before the end of surgery. Patients in group C were given same volume saline. Both groups were given intravenous infusion of 0.3 μg＆#183;kg- 1＆#183;min- 1 in remifentanil, and combined with propofol to maintain anesthesia. All of the patients were used patient-controlled intravenous analgesia （PCIA） after operation. The surgery duration, the dosages of propofol and remifentanil, the first PCIA press time, the number of PCIA press, sufentanil cumulative con-sumption, the case of adding tramadol at postoperative 48 h were recorded. The pain-threshold of the kin and plasma cortisol were detected before the induction （T0）, 4 h after operation （T1）, 12 h after operation （T2）, 24 h after operation （T3）, 48 h after operation （T4）. At the time of T1, T2, T3, T4, the VAS scores were recorded. Results Two groups of patients with operation time, intra-operative remifentanil dosage had no statistical difference. The dosages of propofol, the number of PCIA press, sufentanil cumulative con-sumption, the case of adding tramadol at postoperative 48 h, group D were lower than those of group C （P〈0.05）;The first PCIA press time in group D were longer than that of group C （P〈0.05）; The VAS scores of group D were lower than that of group C at the time of T1 （P〈0.05）;At the time of T1, T2, the pain-threshold of the kin in group D were higher than that of group C and plasma cortisol in group D were lower than that of group C （P〈0.05）. Conclusion In posterior spine surgery, dexmedetomidine can effectively alleviate remifentanil-induced p

关 键 词：前交叉韧带 EdobuRon INTRAFIX 可吸收螺钉 

分 类 号：R681.53[医药卫生—骨科学]