不同剂量右美托咪定联合超低剂量纳洛酮对瑞芬太尼诱发的术后痛觉过敏的影响  

Effect of combined use of different dose of exmedetomidine and ultra-low dose naloxoneon postoperative hyperalgesia induced by remifentanil

作　　者：谭素云[1] 肖圣华[1] 王智钧[1] 韩全国[1] 刘永宏[1] 邱志建[1] 卢钊楷[1] 

机构地区：[1]广东医学院附属东莞市厚街医院麻醉科,523945

出　　处：《实用医学杂志》2015年第15期2486-2489,共4页The Journal of Practical Medicine

摘　　要：目的：探索不同剂量右美托咪定联合超低剂量纳洛酮对瑞芬太尼诱发的术后痛觉过敏的效果。方法：将80例ASAⅠ-Ⅱ级的择期行鼻内镜鼻窦手术女性患者采用随机数字表法随机分为4组，对照组瑞芬太尼组（R组）．瑞芬太尼＋不同剂量右关托咪定＋超低剂量纳洛酮组（RDN1组-RDN3组），观察记录患者术后30min、1、2、4、8、12、24h的疼痛视觉模拟评分，术后第一疼痛时间、镇痛泵有效按压次数、芬太尼使用量和不良反应发生情况。结果：任意时间点平均VAS得分R组〉RDN1组〉RDN2组〉RDN3组，R组与其他3组比较差异有统计学意义，RDN2组和RDN3组在观察的任何时间点均无统计学差异。RDN1组和RDN2组在第一疼痛时间、术后1h按压次数上无统计学差异，RDN2组和RDN3组在术后24h按压次数上无统计学差异，芬太尼用量3组无统计学差异，但均低于R组。结论：右美托咪定联合超低剂量纳洛酮能明显改善瑞芬太尼导致的术后痈觉过敏，其效果随右美托咪定剂量的增加而升高，且这种增高对急性疼痛更敏感。Obejective To explore the effect of combined use of dexmedetomidine and ultra-low dose naloxone on postoperative hyperalgesia induced by remifentanil. Method 80 ASA grade Ⅰ-Ⅱ female patients who were scheduled to perform endoscopic sinus surgery （ESS） were randomly divided into four groups： purely remifentanil group （group R） and remifentanil plus different dosage dexmedetomidine and ultra-low dose naloxone group （group RDN1 - RDN3）. Then the postoperative VAS on 30 min, 1 h, 2 h, 4 h, 8 h, 12 h and 24 h together with the firstpostoperative pain time, PCA press numbers, fentanyl usage and adverse reaction rate were recorded and evaluated. Results Average VAS of group R are higher than other groups in all 7 time points at the adjusted significant level of 0.0083, and group R 〉 group RDN1 〉 group RDN2 〉 group RDN3, while differences between group RDN2 and RDN3 in all time points are not statistical significant.There is no difference between group RDN1 and group RDN2 inthe first postoperative pain time and the PCA press time at lh after operation. Difference between group RDN2 and group RDN3 in the PCA press time at 24 h after operation was not significant, and the fentanyl usage of RDN groups are significantly less than group R. Conclusions Combined use of dexmedetomidine and ultra-low dose naloxone induced by remifentanil can improving patients＇ postoperative hyperalgesia, effect increase with the dose of dexmedetomidine increas, and the increasement is more sensitive in acute pain.

关 键 词：右美托咪定 纳洛酮 瑞芬太尼 痛觉过敏 

分 类 号：R614[医药卫生—麻醉学]