酮咯酸氨丁三醇复合右美托咪定对瑞芬太尼致妇科腹腔镜患者术后痛觉过敏的影响  

Effect of Ketorolac Tromethamine Combined with Dexmedetomidine on Postoperative Hyperalgesia Induced by Remifentanil

作　　者：石泉[1] 李敏[1] 唐志清[1] 谭洪[1] 陈治军[1] SHI Quan;LI Min;TANG Zhiqing;TAN Hong;CHEN Zhijun(Department of Anesthesiology,The Affiliated Hospital of Guilin Medical College,Guilin 541001)

机构地区：[1]桂林医学院附属医院麻醉科,桂林541001

出　　处：《福建医科大学学报》2018年第6期421-424,共4页Journal of Fujian Medical University

基　　金：国家自然科学基金(81460177)

摘　　要：目的探讨酮咯酸氨丁三醇复合右美托咪定对瑞芬太尼诱发术后痛觉过敏的影响。方法选取120例择期行妇科腹腔镜手术患者,随机分为对照组(C组),酮咯酸氨丁三醇组(K组)、右美托咪定组(D组)及酮咯酸氨丁三醇联合右美托咪定组(K+D组),每组30例。C组麻醉诱导期给予等容量生理盐水;K组静脉推注(静注)酮咯酸氨丁三醇30 mg;D组静注右美托咪定1.0μg/kg;K+D组静注右美托咪定0.5μg/kg,静注酮咯酸氨丁三醇15 mg。静注咪达唑仑0.05 mg/kg、舒芬太尼0.6μg/kg、异丙酚2.0 mg/kg及罗库溴铵0.7 mg/kg诱导麻醉。气管插管后行机械通气,维持呼气末二氧化碳分压(P_(ET)CO_2)35～40 mmHg。静注瑞芬太尼0.2～0.3μg·kg^(-1)·min^(-1)、异丙酚4～6 mg·kg^(-1)·h^(-1),间断静注罗库溴铵0.1～0.3 mg/kg,维持BIS值40～60。术后采用舒芬太尼行PCIA,维持VAS评分<4分。比较各组术后30 min,60 min,6 h,12 h及24 h时舒芬太尼用量;比较各组恶心呕吐、低血压、心动过缓、嗜睡及胃肠道出血发生率。结果与C组比较,K,D组及K+D组术后各时点舒芬太尼用量均显著降低(P<0.05);K,D组及K+D组术后各时点舒芬太尼用量比较,差别无统计学意义(P>0.05)。与C组比较,K,D组及K+D组恶心呕吐率显著降低(P<0.05),D组低血压、心动过缓率显著增高(P<0.05);与D组比较,K+D组低血压、心动过缓率显著降低(P<0.05);各组嗜睡率、胃肠道出血比较,差别无统计学意义(P>0.05)。结论酮咯酸氨丁三醇与右美托咪定复合使用时,其降低术后痛觉过敏的作用并不优于两者单独使用,但可减少右美托咪定单独使用时的并发症。Objective To evaluate the effect of ketorolac tromethamine combined with dexmedetomidine on postoperative hyperalgesia induced by remifentanil.Methods 120 patients,scheduled for elective gynecological laparoscopic surgery under general anesthesia,were randomly divided into control group(C group),ketorolac tromethamine group(K group),dexmedetomidine group(D group),and ketorolac tromethamine combined with dexmedetomidine group(K+D group),30 cases in each group.In C group,the equal volume of normal saline was given instead before anesthesia induction.In K group,ketorolac tromethamine 30mg was injected before anesthesia induction.In D group,dexmedetomidine 1.0μg/kg was infused before anesthesia induction.In K+D group,dexmedetomidine 0.5μg/kg was infused before anesthesia induction,and ketorolac tromethamine 15 mg was injected before anesthesia induction.Anesthesia was induced by injection of midazolam 0.05 mg/kg,sufentanil 0.6μg/kg,propofol 2.0 mg/kg,and rocuronium bromide 0.7 mg/kg.After tracheal intubation,the patients were mechanically ventilated,and P ET CO 2 was maintained at 35~40 mmHg.Anesthesia was maintained by injection of remifentanil 0.2~0.3μg·kg^-1·min^-1 and propofol 4~6 mg·kg^-1·h^-1,discontinuously injection rocuronium bromide 0.1~0.3 mg/kg,and BIS value was maintained at 40~60.After operation,PCIA with sufentanil was used,and VAS score was maintained<4 score.Thirty min,60 min,6 h,12 h and 24 h post-operation,the sufentanil consumption were compared between the four groups.The incidence rate of nausea and vomiting,hypotension,bradycardia,drowsiness,and gastrointestinal bleeding were compared between the four groups.Results Compared with C group,the sufentanil consumption in K group,D group,and K+D group significantly decreased(P<0.05).The sufentanil consumption between K group,D group,and K+D group were not statistically different(P >0.05).Compared with C group,the nausea and vomiting rate in K group,D group,and K+D group were significantly decreased(P<0.05),while the hypotension and bradycard

关 键 词：酮咯酸氨丁三醇 右美托咪啶 痛觉过敏 哌啶类 腹腔镜检查 

分 类 号：R614[医药卫生—麻醉学] R971.1[医药卫生—外科学]