右美托咪定平衡无阿片类麻醉与瑞芬太尼平衡麻醉用于多生牙拔除术的药效学研究  

Pharmacodynamic study of dexmedetomidine balanced opioid-free anesthesia and remifentanil balanced anesthesia for supernumerary tooth extraction

作　　者：崔子慧 董彦海 张苗 高娟 CUI Zihui;DONG Yanhai;ZHANG Miao(The NO.2 Hospital of Baoding,Hebei,Baoding 071000,China)

机构地区：[1]河北省保定市第二医院,071000

出　　处：《河北医药》2023年第12期1775-1779,共5页Hebei Medical Journal

基　　金：保定市科学技术研究与发展计划项目(编号:2141ZF012)。

摘　　要：目的探讨右美托咪定平衡无阿片类麻醉与瑞芬太尼平衡麻醉用于多生牙拔除术的药效学。方法患者被随机分配接受术中瑞芬太尼加吗啡(瑞芬太尼组)或右美托咪定(无阿片类药物组)的标准平衡麻醉。所有患者接受术中丙泊酚、七氟醚、地塞米松、利多卡因输注、氯胺酮输注和术后利多卡因输注、扑热息痛、奈福泮和患者自控吗啡。主要结局是拔管后48 h内术后阿片类药物相关不良事件(低氧血症、肠梗阻或认知功能障碍)的综合结果。次要结局是术后疼痛发作、阿片类药物消耗以及术后恶心和呕吐。结果本研究因右美托咪定组出现5例严重心动过缓而提前终止。右美托咪定组156例患者中有122例(78%)发生了主要复合结局,而瑞芬太尼组156例患者中有105名(67%)发生了主要复合结局(相对风险,1.16;95%CI 1.01~1.33;P=0.031)。右美托咪定组152例患者中有110例(72%)发生低氧血症,瑞芬太尼组155例患者中有94例(61%)发生低氧血症(相对风险,1.19;95%CI,1.02至1.40;P=0.030)。肠梗阻或认知功能障碍没有差异。术后0至48 h累计吗啡消耗量[11 mg(5~21)对6 mg(0~17)]和术后恶心和呕吐[156例中的58例(37%)vs.156例中的37例(24%);相对风险,0.64;95%CI 0.45~0.90]在右美托咪定组中均较低,而2组的镇痛措施相似。右美托咪定患者拔管延迟和麻醉后护理病房停留时间更长。结论右美托咪定平衡无阿片类药物麻醉会导致导致严重不良事件的发生率更高,尤其是低氧血症和心动过缓。Objective To investigate the pharmacodynamics of dexmedetomidine balanced opioid-free anesthesia and remifentanil balanced anesthesia for supernumerary tooth extraction.Methods Patients were randomly assigned to receive standard balanced intraoperative anesthesia with remifentanil plus morphine(remifentanil group)or dexmedetomidine(opioid-free group).All patients received intraoperative infusion of propofol,sevoflurane,dexamethasone,lidocaine and ketamine infusion,postoperative infusion of lidocaine,paracetamol,and nefepam,and patient-controlled morphine.The primary outcome was postoperative opioid-related adverse events(hypoxemia,intestinal obstruction,or cognitive dysfunction)within 48 h of extubation.Secondary outcomes were postoperative pain episodes,opioid consumption,and postoperative nausea and vomiting.Results The study was terminated early due to 5 cases of severe bradycardia in the dexmedetomidine group.The primary outcome achieved in 122/156 patients(78%)in the dexmedetomidine group and 105/156 patients(67%)in the remifentanil group(relative risk,1.16;95%CI[1.01,1.33];P=0.031).Hypoxemia occurred in 110/152 patients(72%)of the dexmedetomidine group and 94/155 patients(61%)in the remifentanil group(relative risk,1.19;95%CI[1.02,1.40];P=0.030).There was no significant difference in the incidence of bowel obstruction or cognitive impairment between groups.Cumulative morphine consumption for 48 h postoperatively(11[5,21]mg vs 6[0,17]mg)was significantly less and the incidence of postoperative nausea and vomiting(58/156[37%]vs 37/156[24%];relative risk,0.64;95%CI[0.45,0.90])was significantly lower in the dexmedetomidine group than those of remifentanil group.Analgesic effect was similar between groups.Delayed extubation and longer post-anesthesia care unit stay occurred in dexmedetomidine group.Conclusion Dexmedetomidine-balanced opioid-free anesthesia is associated with higher rates of serious adverse events,especially hypoxemia and bradycardia.

关 键 词：右美托咪定 无阿片类麻醉 瑞芬太尼 多生牙拔除术 

分 类 号：R782.11[医药卫生—口腔医学]