右美托咪定对瑞芬太尼诱发痛觉过敏的影响

Effects of intraoperative dexmedetomidine infusion on remifentanil-induced hyperalgesia

目的探讨术中输注右美托咪定对瑞芬太尼诱发痛觉过敏的影响。方法择期腹腔镜胆囊切除术联合胆道探查术患者50例,随机分为两组,麻醉诱导后分别持续输注右美托咪定0.5μg·kg-1·h-1(D组)或等量生理盐水(C组)。两组患者均输注瑞芬太尼0.3μg·kg-1·min-1并吸入七氟醚维持麻醉,BIS值维持在40～60。术毕所有患者均行芬太尼PCIA,并在PACU观察2h。记录患者术后24、48hVAS评分及镇痛泵按压次数和芬太尼用量。结果与C组比较,D组患者入PACU后第一次VAS≥4分的VAS评分明显减小(P<0.05),VAS<4分时间明显缩短(P<0.01),PACU时PCIA用量明显减少(P<0.05),术后24、48h内PCIA泵按压次数明显减少(P<0.01)。结论术中静注右美托咪定能有效缓解术后疼痛,减少术后镇痛药用量,并能够减轻瑞芬太尼所致痛觉过敏,且不影响患者麻醉苏醒质量。

Objective To investigate the influence of intraoperative dexmedetomidine on remifentanil-induced postoperative hyperalgesia. Methods Fifty patients scheduled for laparoscopic cholecystectomy and biliary passage exploration were randomly divided into two groups. After induction of anesthesia, patients in the group D were given dexmedetomidine via vein at 0. 5 μg·kg-1·h-1 , patients in the group C were given same volume saline. Both groups were given intravenous infusion of 0. 3 μg·kg-1 min-1 remifentanil and inhaled sevoflurane to maintain anesthesia and keep the BIS from 40 to 60. The patients were placed in PACU for 2 h after operation and then patient- controlled intravenous analgesia （PCIA） was used. The following events were recorded： the VAS score of pain when in PACU for 15 min, the time from the administration of PCIA to VAS%4, the total amount of PCIA consumed in PACU, the VAS pain scores at 24 h and 48 h postoperatively. Results Compared with the group C, the average MAC during the surgery decreased significantly in the group D （P〈0.05）, and the VAS score of pain when in PACU for 15 min was significantly lower （P〈0. 05）, the time to VAS of pain%4 was shorter （P〈0. 01）, the times of PCIA usage was decreased by 24 h and 48 h （P〈0. 01）. Conclusion Intraoperative dexmedetomidine can effectively relieve postoperative pain, reduce postoperative analgesic requirements and alleviate remifentanil- induced hyperalgesia without affecting the anesthesia revival.