右美托咪定抑制瑞芬太尼诱发痛觉过敏的量效研究  

Dose-response study on dexmedetomidine for inhibiting remifentanil-induced hyperalgesia

作　　者：杭黎华[1] 束薇薇[2] 陈正[2] 顾志勇[2] 金仁琴[2] 蔡会凤 邵东华[2] HANG Lihua, SHU Weiwei, CHEN Zheng, GU Zhiyong, JIN Renqin, CAI Huifeng, SHAO Donghua.(Department of Anesthesiology, Kunshan Hospital of Jiangsu University, Kunshan 215300, Jiangsu , Chin)

机构地区：[1]江苏大学附属昆山医院麻醉科,江苏昆山215300 [2]江苏大学附属人民医院麻醉科

出　　处：《上海医学》2018年第1期27-29,共3页Shanghai Medical Journal

基　　金：江苏省卫生厅国际交流合作项目(JSH-2011-057);昆山市社会发展基金(KS1716)

摘　　要：目的测定右美托咪定抑制瑞芬太尼诱发痛觉过敏(RIH)的半数有效量(ED_(50))。方法选择择期在全身麻醉下行腹腔镜胆囊切除术的患者64例,随机区组设计分为8组,每组8例。麻醉诱导前15min,各组分别恒速经静脉泵注射右美托咪定0.28μg/kg(右美1组)、0.40μg/kg(右美2组)、0.57μg/kg(右美3组)、0.81μg/kg(右美4组)、1.16μg/kg(右美5组),氯胺酮1.0mg/kg(氯胺酮组),芬太尼6μg/kg(芬太尼组);对照组经静脉泵注射等量0.9%氯化钠溶液。麻醉维持均采用经静脉泵注射瑞芬太尼0.25μg/(kg·min)和丙泊酚4～5mg/(kg·h)。记录手术时间、拔除气管导管时间和拔管后的Ramsay镇静评分。在患者清醒拔管后30min对患者进行疼痛视觉模拟评分(VAS评分)。疼痛VAS评分≤3分认为抑制RIH有效,>3分则认为抑制RIH无效。采用probit法获得右美托咪定抑制RIH的ED_(50)和95%CI。结果 8组患者间年龄、性别构成、体重、瑞芬太尼用量、手术时间、拔除气管导管时间和拔管后Ramsay镇静评分的差异均无统计学意义(P值均>0.05)。对照组清醒拔管后30 min的疼痛VAS评分显著高于除右美1组外的其他各组(P值分别<0.05、0.01)。右美2、右美3、右美4、右美5组抑制RIH的有效例数逐渐增多,右美5、氯胺酮和芬太尼组可完全抑制RIH。右美托咪定抑制RIH的ED_(50)为0.54μg/kg(95%CI为0.42～0.70μg/kg)。结论右美托咪定可抑制瑞芬太尼诱发腹腔镜胆囊切除术后RIH,其ED_(50)为0.54μg/kg。Objective To determine the median effective dose （EDs0） of dexmedetomidine for inhibiting remifentanil-induced hyperalgesia （RIH）. Methods Totally 64 patients scheduled for laparoscopic cholecystectomy under general anesthesia were enrolled in this study and randomly divided into 8 groups （n = 8）. They received dexmedetomidine 0.28, 0.40, 0.57, 0.81 and 1.16 μg/kg （group D1, D2, D3, D4, D5）, ketamine 1.0 mg/kg （group K）, fentanyl 6 μg/kg （group F）, and normal saline （group C） at 15 minutes before the induction of anesthesia. Remifentanil 0.25 μg/（kg · min） and propofol 4-5 mg/（kg · h） were intravenously injected for the maintenance of anesthesia. The operation time, extubation time and Ramsay score after extubation were recorded. Postoperative pain was assessed by visual analog scale （VAS） at 30 minutes after extubation. VAS score ≤3 was defined as effective analgesia. The ED50 of dexmedetomidine on RIH and 95% CI were determined by probit method. Results There was no significant difference in the age, sex composition, weight, remifentanil consumption, operation time, extubation time or Ramsay score among the eight groups （all P〉0.05）. VAS score was significantly lower in group D2, D3, D4, D5, K and F at 30 minutes after extubation than that in group C （P〈 0.05 or 0.01, respectively）. The number of RIH inhibition increased gradually in group D2, D3, D4 and D5. RIH almost completely reversed in group DS, K and F. The ED50 of dexmedetomidine for prevention of RIH was 0.54 μg/kg （95% CI, 0. 42 -- 0. 70 μg/kg）. Conclusion Dexmedetomidine can alleviate RIH after laparoscopic cholecystectomy and the ED50 is 0.54 μg/kg. （Shanghai Med J, 2018, 41 ： 27-29）

关 键 词：右美托咪定 瑞芬太尼 痛觉过敏 量效关系 

分 类 号：R614[医药卫生—麻醉学]