右美托咪定联合曲马多预防瑞芬太尼麻醉后痛觉过敏的临床研究

Clinic study of dexmedetomidine with tramadol to prevent postoperative hyperalgesia induced by remifentanil

目的观察右美托咪定联合曲马多用于预防瑞芬太尼麻醉后痛觉过敏效果及不良反应。方法选择70例妇科择期全麻手术的患者,随机分为2组:A组:全麻插管后静脉泵注右美托咪定1μg·kg-1,10min后改为0.4μg·kg-1·h-1至手术结束前30min停药,缝皮前静注曲马多1mg·kg-1;B组:术中泵注等量生理盐水,缝皮前静注曲马多1.5mg·kg-1。记录所有患者的手术时间、苏醒时间、苏醒室停留时间。于拔管后即刻及术后20,40和60min对患者进行Ramsay镇静程度评级,并于拔管后即刻、术后30,60和90min对患者进行疼痛(VAS)评分。结果 A组患者术后早期镇静评分明显高于B组(P<0.05),2组患者术后VAS评分,差异无统计学意义(P>0.05),A组患者术后恶心、呕吐、寒战的发生率低于B组(P<0.05)。结论右美托咪定联合曲马多可有效预防瑞芬太尼麻醉后痛觉过敏,且不明显增加复苏时间,获得良好的术后镇静,两者合用可减少曲马多用量,减少术后恶心呕吐、寒战的发生。

Objective To observe the preventive efficacy and safety of dexmedetomidine with tramadol on the patients with postoper-ative hyperalgesia induced by remifentanil .M ethods 70 patients ASA （Ⅰ-Ⅱ） undergoing elective surgery under general anesthe-sia were randomly assigned into two groups ：The patients in group A were given intravenous injection of 1 μg · kg -1 · h-1 with mini-pump for ten minutes after the intubation ,then received intravenous injection of 0 .4 μg · kg -1 · h-1 consistently till 30 min before the end of the operation ,and received intravenous injection of tramadol 1 mg · kg -1 before the suturing .The patients in group B were given intravenous injection of the normal saline with the same dose and rate at the same time during the operation , and received intravenous injection of tramadol 1 .5 mg · kg -1 before the suturing .The operation time ,recovery time ,and the time stay in PACU were recorded .Adverse effects ,VAS and Ramsay scores were also recorded .Results Compared with group A , VAS score had no significant difference in group B （P〉0 .05） ,Ramsay scores was significantly lower in group B early after opera-tion （P〈0 .05） ,the incidence of patients with postoperative nausea and vomiting ,shiver was higher in group B（P〈0 .05） .Con-clusion Dexmedetomidine combined with tramadol can effectively prevent hyperalgesia after remifentanil anesthesia without signif-icant increase in revival time ,and obtain a better sedation .