预注射小剂量右美托咪定或怕瑞西布对瑞芬太尼麻醉后痛觉过敏的影响

The Influence of Pretreated Dexmedetomidine or Parecoxib on Hyperalgesia After Remifentanil Anesthesia

目的：观察分别预注射小剂量右美托咪定、怕瑞西布对瑞芬太尼麻醉后痛觉过敏的影响。方法全身麻醉下行开腹子宫切除术患者60例，随机均分为3组。对照组：麻醉前30min静脉注射生理盐水10mL（NS组）；实验组：麻醉前30min静脉注射右美托咪定0.5μg/kg（D组）或帕瑞昔布0.5mg/kg（P组）。3组患者均以3μg/L靶控输注瑞芬太尼，靶控输注丙泊酚（血浆靶浓度4mg/L）行麻醉诱导和维持。术后在麻醉恢复室（PACU）停留观察2h，送返病房后患者行静脉自控镇痛（PCIA）。患者在PACU期间应用VAS疼痛评分法疼痛评分，若VAS评分≥4分或者患者要求镇痛，静脉给予吗啡1-2mg。记录VAS评分≥4分时间（从麻醉停药后至第一次VAS评分≥4分的时间），第一次≥4分的VAS评分，静脉注射吗啡后VAS评分＜4分所需时间，PACU中吗啡用量，术后15、30、45、60、90、120min VAS评分和不良反应发生情况。结果与NS组比较，实验组术后VAS评分≥4分时间延长，PACU中吗啡用量减少，术后30、45、60、90、120min的VAS评分减少（P＜0.05）；P组和D组比较各观察指标差异无统计学意义。结论预先注射小剂量右美托咪定或怕瑞西布均可缓解瑞芬太尼麻醉后痛觉过敏，二者效果没有统计学差异。

Objective To investigate the inlfuence of pretreated dexmedetomidine or parecoxib on hyperalgesia after remifentanil anesthesia. Methods Sixty ASAⅠorⅡfemale patients undergoing elective abdominal hysterectomy with general anesthesia were included in this prospective, double-blind, randomized study. The patients were randomly divided into 3 groups. Control group：the patients pretreated Sodium Chloride 10mL（group NS） before anesthesia 30 min;experimental group：the patients pretreated or dexmedetomidine 0.5μg/kg（group D）or parecoxib 0.5mg/kg（group P）before anesthesia 30 min. Anesthnia was induced and maintained with IV infusion of remifentail at target plasma concentration 3μg/L and propofol at target plasma concentration 4mg/L.Tracheal catheter intubation was facilitated with cisatracurium besilate 0.2mg/kg. The patients were mechanically ventilated（Vt 8~12mL/kg, RR 12bpm, O2：air 1∶1）, PETCO2 was maintained at 35~45mmHg. The patients were placed in PACU for 2 h after operation and then transported to the ward. All patients received PCIA with morphine（concentration 1mg/mL, backgroud infusion 2mL/h, bolus dose 2mL, lockout time 10min）after operation. Morphine 2mg was given if patients VAS≥4, 5 min later could repeat until the patients VAS〈4. The following events were recorded：①the total amount of propofol consumed during anesthesia;②the time between the end of operation to the patients ifrst VAS≥4;③the score of the patients ifrst VAS≥4;④the time between the administration of morphine to VAS〈4;⑤the total amount of morphine consumed during 2h stay in PACU;⑥the VAS score recorded at the time15, 30, 45, 60, 90, 120min after operation and⑦the incidence of adverse effects. Results Compare with group NS , in groupD and groupP, the time between the end of operation to the patients ifrst VAS≥4 were prolonged（P〈0.05）, the score of the patients at the time of 30, 45, 60, 90, 120 min after operation were low（P〈0.05）, the morphine consumption were decreased（P〈0.05）during 2h stay in PACU;there is not statistical difference of effects between dexmedetomidine and parecoxib on hyperalgesia after remifentanil anesthesia. Conclusion The pretreating either dexmedetomidine or parecoxib to prevent hyperalgesia were effective after remifentanil anesthesia and the effects have not statistical difference.