右美沙芬超前镇痛对瑞芬太尼麻醉心血管反应及术毕伤口疼痛的影响

The Effect of Dextromethorphan Preemptive Analgesia on Cardiovascular Responses and Postoperative Pain in Remifentanil Anesthesia

目的观察右美沙芬超前镇痛对瑞芬太尼麻醉下腹腔镜胆囊切除术患者的心血管反应及术毕伤口疼痛情况的影响。探讨右美沙芬超前镇痛在瑞芬太尼麻醉中的效应。方法选择ASAⅠ～Ⅱ级腹腔镜胆囊切除术患者40例，随机分为瑞芬太尼组（R组）和右美沙芬组（D组），每组20例。麻醉诱导：咪达唑仑0．05mg／kg、丙泊酚1．5～2．0mg／kg、维库溴铵0．08mg／kg和瑞芬太尼1．5μg／kg。麻醉维持：以微量泵泵入丙泊酚3～6mg／（kg·h）和瑞芬太尼5～10μg／（kg·h），并间断静注维库溴铵；D组患者于术前30min肌注右美沙芬20mg。两组患者均于术毕前10min停止麻醉用药。术中监测并记录入室时、诱导后、气管插管后1min、5min、10min、切皮时、拔管后的MAP、HR及SpO2的值，术毕统计术中丙泊酚和瑞芬太尼的用量，并对患者伤口疼痛进行VRS评分。结果两组患者在麻醉诱导后MAP均显著下降，同入室时比较有极显著性差异（P〈0．01），而HR的变化不大（P〉0．05）；但两组患者同时点相比无显著性差异（P〉0．05）。术中R组丙泊酚和瑞芬太尼用量均多于D组。术毕伤口疼痛VRS评分为0分、1分、2分和3分者，D组分别有8例、7例、5例和0例；R组分别有2例、4例、11例和3例，D组无痛者明显少于R组（P〈0．05）。结论右美沙芬具有超前镇痛的效应，用于瑞芬太尼麻醉的腹腔镜胆囊切除术患者中，不但对患者心血管反应的影响轻微，而且可以减少术中丙泊酚和瑞芬太尼的用量，且更大程度地减轻了术毕时患者伤口的疼痛。

Objective To evaluate the effect of dextromethorphan（Shuanghongling）preemptive analgesia on cardiovascular responses of patients undergoing laparoscopic cholecystectomy（LC）in remifentanil anesthesia, as well as on local pain at the end of operation. Methods Sixty ASA Ⅰ～Ⅱ patients undergoing LC were randomly divided into two groups（n=20 each）：remifentanil group（R） and dextromethorphan group （D）. General anesthesia was induced with midazolam 0.05 mg/kg,propofol 1.5～2.0 mg/kg,vecuronium 0.08 mg/kg and remifentanil 1.5 9g/kg. Anesthesia was maintained with propofol 3～6 mg/（kg·h）,remifentanil 5～10μg/（kg·h）and vecuronium. Dextromethorphan 20 mg was given to the patients in group D at 30 minutes before operation. MAP, HR, SpO2 were measured pre-anesthesia, pre-and post-incubation. The general usage of propofol and remifentanyl were noted. Pain intensity was measured with VRS at the end of operation. Results There was no significant difference between the two groups in MAP, HR, SpO2 at all time points（P〉0.05）. The total dosages of propofol and remifentanil of the patients in dextromethorphan group were lower, but the difference was not statistically significant between the two groups（P〉0.05）. The Number of painless patients in group D was signifieantiy lower than that in grop R （P〈0.05）. Conelusion Dextromethorphan preemptive analgesia in patients undergoing LC in remifentanil anesthesia can attenuate cardiovascular responses. Further more, it can reduce operative opioid consumption and relieve the local pain at the end of operation.