右美托咪定对瑞芬太尼持续输注下腹腔镜胆囊切除术患者机械痛觉阈值的影响  

Effects of Dexmedetomidine on postoperative mechanical pain threshold in patients undergoing laparoscopic cholecystectomy

作　　者：李建玉[1] 杨秀环[2] 董文芳[2] 陆建华[2] 

机构地区：[1]解放军421医院麻醉科,广州市510010 [2]广州军区广州总医院麻醉科,510010

出　　处：《实用医学杂志》2015年第21期3574-3577,共4页The Journal of Practical Medicine

基　　金：国家自然科学基金面上项目(编号:81371233)

摘　　要：目的:观察右美托咪定(dexmedetomidine,Dex)对瑞芬太尼为镇痛药的全麻腹腔镜胆囊切除术患者机械痛觉域值的影响,明确Dex是否可以预防此类患者的痛觉过敏。方法:择期行腹腔镜胆囊切除手术患者120例,随机分为3组:右美托咪定组(D组)、帕瑞昔布钠组(P组)和对照组(C组)。各组麻醉维持用药为异丙酚及瑞芬太尼,D组加用Dex,P组加用帕瑞昔布钠,C组不使用Dex及帕瑞昔布钠。观察患者术后2、4、8、12、24、48 h的机械痛觉域值及视觉模拟评分(VAS)。结果:C组各时相点的痛觉阈值较术前显著下降(P<0.01);P组仅术后12、24、48 h的痛觉阈值下降(P<0.05);D组术后机械痛域值与术前相比差异无统计学意义(P>0.05)。与C组比较,D组术后机械痛觉阈值皆增高,P组仅术后2、4、8 h的机械痛觉阈值增高;与P组比较,D组的机械痛觉阈值在术后12、24、48 h增加。与术前相比,各组术后各时间点的VAS值升高(P<0.05),患者术后VAS值与机械痛觉阈值无相关性。结论:右美托咪定可以抑制瑞芬太尼麻醉下腹腔镜胆囊切除术患者的痛觉过敏,其抑制作用的持续时间优于帕瑞昔布钠。Objective To identify whether dexmedetomidine can prevent postoperative hyperalgesia of patients undergoing laparoscopic cholecystectomy. Methods One hundred and twenty patients undergoing elective Laparoscopic cholecystectomy were randomly divided into three groups：dexmedetomidine group （group D, patients receiving dexmedetomidine）, parecoxib sodium group （group P, patients receiving parecoxib sodium） and control group（group C）. Mechanical pain thresholds on periincisional area and VAS score were recorded 2, 4, 8, 12, 24, 48 h after surgery. Results Mechanical pain thresholds in group C at 2, 4, 8, 12, 24, 48 h after operation decreased significantly compared with that before operation （P 〈 0.01 ） but that in group D had no significant difference, and the thresholds in group P at 4 h, 8 h had no significant decrease. Compared with that in group C, mechanical pain thresholds in group D increased at 2, 4, 8, 12, 24, 48 h after operation（P 〈 0.05）, and that in group P increased at 4 h and 8 h after operation（P 〈 0.05）. Compared with that in group P, mechanical pain thresholds in Group D increased at 12,24,48 h after operation. Compared with preoperative VAS values, values were significantly increased in every group（P 〈 0.05）. Furthermore, postoperative VAS val- ues had no correlation with mechanical pain threshold in each group and the incidence of adverse reactions had no significant difference among three groups（P 〉 0.05）. Conclusion Dexmedetomidine can prevent postoperative hyperalgesia in patients undergoing laparoscopic cholecystectomy.

关 键 词：右美托咪定 帕瑞昔布钠 瑞芬太尼 机械痛觉阈值 

分 类 号：R614[医药卫生—麻醉学]