术中持续输注右美托咪定对降低经腹子宫切除术后慢性疼痛的影响  

Dexmedetomidine preventive chronic post-hysterectomy pain

作　　者：阮志慧[1] 冯顺华[1] 韩超[1] 葛志军[1] 赵海龙 马铁梁[2] 

机构地区：[1]江苏省宜兴市人民医院麻醉科,214200 [2]江苏省宜兴市人民医院中心实验室,214200

出　　处：《临床麻醉学杂志》2017年第12期1155-1158,共4页Journal of Clinical Anesthesiology

基　　金：无锡市科技局医疗与公众健康技术研发项目(CSE31N1522)

摘　　要：目的探讨右美托咪定预先镇痛对全麻经腹子宫切除术患者术后慢性疼痛(CPSP)的影响。方法择期行全麻经腹子宫切除术患者71例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为右美托咪定组(D组,n=37)和对照组(C组,n=34)。两组患者均行丙泊酚-瑞芬太尼全凭静脉麻醉。从麻醉诱导开始至手术结束气管拔管,D组持续静脉输注右美托咪定0.5μg·kg^(-1)·h^(-1),而C组则给予生理盐水0.125ml·kg^(-1)·h^(-1)。术后患者均接受芬太尼静脉自控镇痛。记录术中生命体征、围术期镇痛镇静药用量和不良反应。电话随访评估术后3、6、12个月的CPSP发生情况。结果两组患者围术期生命体征均平稳,未见明显不良反应,D组术后补救镇痛使用曲马多总量明显少于C组[(58.8±15.4)mg vs(78.9±24.5)mg,P<0.05]。术后3、6、12个月,D组CPSP发生率分别为10.8%、5.4%、2.7%,明显低于C组的35.3%、26.5%、17.6%(P<0.05)。D组术后3、6个月神经病理性疼痛(NP)发病率分别为2.7%、0%,明显低于C组的17.6%、14.7%(P<0.05)。结论右美托咪定预先镇痛可以降低经腹子宫切除术后CPSP的发生率。Objective To investigate the effects of dexmedetomidine preventive on chronic postsurgical pain（CPSP）in patients undergoing hysterectomy.Methods Eighty patients scheduled for elective abdominal hysterectomy,aged 18-65 years,ASA physical statusⅠ orⅡ were recruited,and randomly divided into dexmedetomidine group（group D）and the control group（group C）.All patients received total intravenous anesthesia with propofol and remifentanil.The patients in group D were administered intravenously dexmedetomidine 0.5μg·kg^（-1）·h^-1 from anesthesia induction to extubation at the end of surgery,while the patients in group C were administered normal saline 0.125 ml·kg^（-1）·h^-1.All patients received patient-controlled analgesia with fentanyl postoperatively.Intraoperative vital signs,the dose of analgesic and sedatives,and adverse reactions were recorded.CPSP and neuropathic pain（NP）were evaluated through the telephone follow-up in 3,6 and 12 months postoperatively.Results The peri-operative vital signs of both groups were stable,and no obvious adverse reaction were observed.The dosage of tramadol used for resue analgesia in group D was lower than that in group C [（58.8±15.4）mg vs（78.9±24.5）mg,P〈0.05].Seventy-one of eighty patients completed all follow-up（37 in group D,34 in group C）.The incidence of CPSP in postoperative3,6 and 12 months were 10.8%,5.4%,2.7%in group D,significantly lower than 35.3%,26.5%,17.6%in group C,respectively（P〈0.05）.The incidence of NP in postoperative 3 and 6 months were 2.7%,0%,significantly lower than 17.6%,14.7% in group C,respectively（P〈0.05）.Conclusion Dexmedetomidine preventive analgesia alleviate chronic post-hysterectomy pain.

关 键 词：右美托咪定 预先镇痛 术后慢性疼痛 子宫切除术 

分 类 号：R614[医药卫生—麻醉学]