预注射小剂量氯胺酮或右美托咪定对瑞芬太尼全身麻醉后痛觉过敏的影响  

The Effect of Pre-injection of Small dose of Ketamine or Dexmedetomidine on Hyperalgesia after Remifentanil Anesthesia

作　　者：廖益永[1] 黄典[1] 邬文伟[1] 

机构地区：[1]广东省梅州市人民医院麻醉科,梅州514031

出　　处：《海峡药学》2016年第5期82-84,共3页Strait Pharmaceutical Journal

摘　　要：目的探讨预注射小剂量氯胺酮或右美托咪定对瑞芬太尼全身麻醉后痛觉过敏的影响。方法选取我院于2012年10月至2014年10月的90例全身麻醉下经腹全子宫切除术患者进行分析,随机分为3组各30例,A组在麻醉前30min静脉注射生理盐水10m L,B组在麻醉前30min静脉注射氯胺酮0.5mg·kg-1,C组在麻醉前30min静脉注射右美托咪定0.5μg·kg-1。用视觉模拟评分(VAS)法对在恢复室期间的患者进行疼痛评分,观察并记录患者VAS评分情况、用药量及观察时间点VAS评分进行比较。结果 B组和C组的苏醒时间和拔管时间明显少于A组,具有统计学意义(P<0.05);B组和C组的苏醒时间和拔管时间没有明显差异,无统计学意义(P>0.05);与A组比较,术后B组和C组的观察时间点VAS评分比较明显低于A组,具有统计学意义(P<0.05)。而且随着时间的延长VAS评分逐渐降低,到2h后达到最低分。结论预注射小剂量氯胺酮或右美托咪定对瑞芬太尼全身麻醉后痛觉过敏具有明显缓解作用,而且麻醉后可以尽快的苏醒,值得临床推广使用。OBJECTIVE To investigate the influence of the pre-injection of small dose ketamine or dexmedetomidine on hyperalgesia after remifentanil anesthesia. METHODS 90 cases for total hysterectomy in our hospital from October 2012 to October 2014 were selected. Patients were randomly assigned to 3 groups,with 30 patients in each group. Patients in group A were given intravenous injection of normal saline 10 m L half an hour before remifentanil anesthesia,patients in group B were given intravenous injection of ketamine with 0. 5mg·kg- 1half an hour before anesthesia,patients in group C were given intravenous dexmedetomidine with 0. 5μg·kg- 1half an hour before anesthesia. Pain score of patients in the recovery room was evaluated by visual analogue scale（ VAS）,and the VAS score,drug dosage were compared between the patients. RESULTS In group B and group C,the recovery time and pulling tube time was less than that in group A with statistical significance（ P〈0. 05）. In B group and C group,the recovery time and pulling tube time,there was no significance（ P〈0. 05）. About VAS score in group B and group C at the observation time point compared with group A after operation,there was significantly lower than that in group A,with statistical significance（ P〈0. 05）. And with the extension of time,the VAS score gradually reduced to the lowest point after 2 hours. CONCLUSION Pre-injection of small dose ketamine and medetomidine after remifentanil anesthesia has obvious relief about hyperalgesia,and wake up as soon as possible after anesthesia,it is worth for clinical use.

关 键 词：氯胺酮 右美托咪定 瑞芬太尼 痛觉过敏 

分 类 号：R969.4[医药卫生—药理学]