不同剂量右美托咪定预给药对瑞芬太尼致术后疼痛与痛觉过敏的影响

The efficacy of dexmedetomidine administration of remifentanil given on postoperative pain and hyperalgesia

目的探讨不同剂量右美托咪定预给药对瑞芬太尼致术后疼痛与痛觉过敏的影响。方法随机选择全凭静脉全麻下腹部开腹手术及腹腔镜手术患者各80例,按右美托咪定使用剂量分为小剂量(0.2μg/kg)右美托咪定组(LDex组)、中剂量(0.6μg/kg)右美托咪定组(MDex组)和高剂量(1μg/kg)右美托咪定组(HDex组)及对照组各20例,对比各组瑞芬太尼用量、曲马多用量、机械性痛阈、VAS疼痛程度和Ramsay评分。结果开腹手术患者组的HDex组术后无需使用曲马多镇痛,腹腔镜手术组的MDex组和HDex组术后无需使用曲马多镇痛。开腹手术组和腹腔镜手术组机械性痛阈均与右美托咪定用量呈正相关(r=0.42、0.43,P<0.05),开腹手术高剂量(1μg/kg)右美托咪定拔管后24h基本恢复正常,腹腔镜手术中剂量(0.6μg/kg)右美托咪定拔管后24h基本恢复正常。开腹手术组和腹腔镜手术组疼痛程度评分均与右美托咪定用量呈负相关(r=-0.39、-0.41,P<0.05)。结论右美托咪定在开腹或腹腔镜手术时预给药均能减轻瑞芬太尼致术后疼痛感觉和痛觉过敏,并存在剂量依赖效应,开腹手术所需给药剂量高于腹腔镜手术。

Objective To study dexmedetomidine administration of remifentanil given post operative pain and hyperalgesia induced effects. Methods Total intravenous anesthesia randomly selected lower abdominal laparotomy and laparoscopic surgery of the 80 cases, press the right medetomidine dose were divided into small doses （0.2μg/kg） dexmedetomidine given group （LDex group ）, medium dose （0.6μg/kg） dexmedetomidine given group （MDex group） and high dose （lμg/kg） dexmedetomidine given group （HDex group） and control group,each of 20 cases, compared the group remifentanil fentanyl dosage, tramadol dosage, mechanically pain threshold, VAS pain and Ramsay score. Results The patient group HDex open surgery without the use of postoperative analgesic tramadol, laparoscopic surgery group MDex group and HDex group were without the use of tramadol. Open surgery and laparoscopic surgery group group mechanical pain threshold were associated with the amount of dexmedetomidine had negative correlation（r = 0.42, 0.43, P 〈0.05）, laparotomy high dose （lμg/kg） dexmedetomidine 24h after extubation care given microphone returned to normal, laparoscopy dose （0.6μg/kg） dexmedetomidine given 24h after extubation basically returned to normal. Open surgery and laparoscopic surgery group pain scores were associated with the amount of dexmedetomidine had negative correlation （r = -0.39, -0.41, P 〈0.05）. Conclusion Dexmedetomidine set at laparotomy or laparoscopic surgery can reduce pre-administration of remifentanil induced postoperative pain sensation and hyperalgesia in a dose-dependent effect, the dose required in open surgery is higher than in laparoscopic surgery.