不同剂量右美托咪定与小剂量氯胺酮预防瑞芬太尼复合麻醉后痛觉过敏的效果比较

Comparison of preventive effects of different dose of dexmdetomidine and low-dose keta mine on remifentanil-induced acute postoperative hyperalgesia

目的比较不同剂量右美托咪定与小剂量氯胺酮预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果。方法择期行鼻内镜下鼻窦手术的女性患者100例,ASAⅠ或Ⅱ级,按随机数字表法分为瑞芬太尼组(R组),瑞芬太尼+0.4μg/kg右美托咪定组(RD1组)、瑞芬太尼+0.6μg/kg右美托咪定组(RD2组)、瑞芬太尼+0.8μg/kg右美托咪定组(RD3)、瑞芬太尼组+氯胺酮组(RK组),每组20例。RD1、RD2和RD3组诱导后分别给予右美托咪定0.4、0.6和0.8μg/kg,RK组诱导后给予氯胺酮0.8mg/kg,五组患者术中瑞芬太尼输注速率均为0.3μg·kg-1·min-1,复合丙泊酚维持麻醉。记录手术时间、拔管时间,拔管即刻进行OAA/S评分,术后15、30min、1、2、4、8、24hVAS评分,观察并记录拔管后2、24h芬太尼用量以及术后恶心、呕吐等不良反应发生率。结果与R组比较,其他四组术后各时点VAS评分明显下降(P<0.05)。与RD1组比较,术后各时点RD2组、RD3组、RK组VAS评分明显下降(P<0.05)。与RD3组比较,R组、RD1组、RD2组、RK组拔管即刻OAA/S评分1级例数明显增加、2级例数明显减少(P<0.05)。R组拔管后2h及24h内芬太尼用量分别为(50±10)μg和(65±13)μg,其他四组均未使用芬太尼(P<0.05)。不良反应发生率R组为7例,RK组为6例,明显高于RD1组1例、RD2组1例和RD3组0例(P<0.05)。结论 0.6μg/kg右美托咪定可预防瑞芬太尼诱发的术后急性痛觉过敏,且术后不良反应的发生率低。

Objective To compare the preventive effects of different dose of dexmdetomidine and low dose keta mine on remifentanil-induced acute postoperative hyperalgesia. Methods One hundred patients （ASA I or Ⅱ , women, aged 18-59） scheduled for endoscopic sinussurgery were divided into five groups randomly （n=20） ： remi fentanil group （group R）, remifentanil-0.4 μg/kg dexmedetomidine （group RD1 ）, remifentanil 4- 0.6 μg/kg dexmedetomidine group （group RD2）, remifentanil- 0.8 μg/kg dexmedetomidine group （group RD3）, remifentanil ＋ keta mine （group RK）. After induction of anesthesia, 0.4, 0.6 and 0.8μg/kg dexmedetomidine were ad ministered intravenously in group RD1, RD2, RD3 respectively, but 0.8 mg/kg keta mine in group RK. Anesthesia was mained with remifentanil 0.3 μg·kg 1. min ·-1in combination with propofol. Surgery duration, extubation time, OAA/S scores after extubation, VAS scores at 15, 30 min, 1, 2, 6, 12 and 24 h after operation, incidence of adverse effects were recorded. Results VAS scores after operation were significantly lower in group RD2, RD3, RK than in group RD1 （P〈C0.05）, there were no significant differences in VAS scores after operation in group RD2, RD3, RK. OAA/S grade 2 proportion of patients was significantly lower in the other 4 groups than in group RD1. The consumption of fentanil at 2 h （50±10） μg and 24 h （65±13） μg after extubation were significantly lower in group RD1,RD2, RD3,RK than in group R （P〈0.05）. The incidences of adverse effects in group RD1, RD2 and RD3 were significant lower than in group R and RK （P 〈0.05）. Conclusion There is no significant differences in the preventive effects of some dose of dexmedetomidine and low-dose keta mine on remifentanil-induced acute postoperative hyperaigesia,but dexmedetomidine can reduce the incidences of adverse effects.