右美托咪定在老年患者子宫颈癌根治术中对瑞芬太尼麻醉后痛觉过敏的影响  

Effect of dexmedetomidine on hyperalgesia induced by remifentanil anesthesia in cervical cancer radical resection

作　　者：杨涛[1] 周日永[1] 张竞雄[1] 杨沛[1] 徐旭仲[1] 

机构地区：[1]温州医科大学附属第一医院麻醉科,325000

出　　处：《中国医药》2016年第11期1687-1690,共4页China Medicine

摘　　要：目的探讨右美托咪定在老年患者子宫颈癌根治术中对瑞芬太尼麻醉后痛觉过敏的影响。方法选取2013年8月至2014年12月于温州医科大学附属第一医院行子宫颈癌根治术老年患者76例，按照随机数字表法分为观察组和对照组，各38例。2组麻醉维持中给予瑞芬太尼0．15μg／（kg·min），同时观察组持续泵注右美托咪定0．5μg／（kg·h），对照组输注等量0．9％氯化钠注射液。观察组术后静脉自控镇痛（PCIA）给予右美托咪定2μg／kg＋舒芬太尼3μg/kg＋昂丹司琼8mg，对照组给予舒芬太尼3μg/kg＋昂丹司琼8mg，均溶于0．9％氯化钠注射液100ml。比较2组术后30、90min和4、24h的疼痛视觉模拟量表（VAS）评分，术后24h内舒芬太尼用量、PCIA总按压次数、术后24hRamsay镇静评分和不良反应发生情况。结果观察组术后30、90min的VAS评分明显低于对照组[（2．7±0．3）分比（3．6±0．5）分、（2．0±0．3）分比（3．2±0．4）分]，差异有统计学意义（P〈0．05）。但2组术后4、24h的VAS评分比较，差异无统计学意义（P〉0．05）。观察组术后24h内舒芬太尼用量、PCIA总按压次数均明显低于对照组[（82±6）μg比（111±8）μg、（7．8±2．2）次比（13．4±2．6）次]，且术后24hRamsay镇静评分明显高于对照组[（2．7±0．6）分比（2．0±0．5）分]，差异均有统计学意义（均P〈0．05）。2组术后恶心呕吐、烦躁、寒战发生率差异无统计学意义（P〉0．05）。2组均未发生低血压、心动过缓、过度镇静。结论在子宫颈癌根治术中持续泵注小剂量的右美托咪定，能有效减轻患者术后早期疼痛，减少镇痛药用量，同时能预防瑞芬太尼麻醉引起的痛觉过敏现象。Objective To expore the effect of dexmedetomidine on hyperalgesia induced by remifentanil anesthesia in cervical cancer radical operation. Methods Totally 76 elderly patients who had cervical cancer radical resection from August 2013 to December 2014 in the First Affiliated Hospital of Wenzhou Medical University were randomly divided into observation group and control group, with 38 cases in each group. Both groups were given remifentanil 0. 15 μg/（ kg · min） for anesthesia maintenance; the observation group had continuous pump-injected dexmedetomidine 0.5 μg/（ kg· h） ; the control group was given equivalent 0.9% sodium chloride injection. After operation, the observation group had patient controlled intravenous analgesia （PCIA） with dexmedetomidine 2 μg/kg ± sulfentanyl 3 μLg/kg ± ondansetron 8 mg; the control group had PCIA with sulfentanyl 3 μg/kg ± ondansetron 8 rag. At 30 min, 90 min, 4 h, 24 h after operation, Visual Analogue Scale（VAS） scores were analyzed. At 24 h after operation, dosages of sulfentanyl, total demand times of PCIA and Ramsay scores were analyzed. Adverse reactions were observed. Results VAS scores in observation group were significantly lower than those in control group at 30 min and 90 min after operation, [ （2.7 ± 0.3 ） scores vs （ 3.6 ± 0 5 ） scores, （2.0 ± 0.3 ） scores vs （ 3.2 ± 0.4 ） scores ] （ P 〈 0.05 ）. At 24 h after operation, the dosage of sulfentanyl and total demand times of PCIA in observation group were significantly lower than those in control group, Ramsay score in observation group was significantly higher than that in control group [ （ 82 ± 6 ） μg vs （ 111 ± 8 ） μg, （ 7.8 ± 2.2） times vs （ 13.4 ± 2.6） times, （2.7 ± 0.6） scores vs （2.0 ± 0.5 ） scores ] （ P 〈 0.05 ）. Incidences of nausea and vomiting, agitation, shivering had no significant differences between groups （ P 〉 0. 05 ）. There were no hypotension, bradyeardia and over sedation in both groups. Conclusion Continuous pu

关 键 词：子宫颈癌 右美托咪定 瑞芬太尼 痛觉过敏 

分 类 号：R737.3[医药卫生—肿瘤]