右美托嘧啶复合帕瑞昔布对老年患者瑞芬太尼输注后痛觉过敏的影响

Effect of dexmetomidine and parecoxib on remifentanil-induced hyperalgesia in elderly patients

目的 研究右美托嘧啶复合帕瑞昔布预处理或后处理对老年患者瑞芬太尼痛觉过敏的影响.方法 选择ASAⅡ或Ⅲ级择期行腹腔镜胆囊切除术的老年患者（60～75岁）60例,随机分为预处理组（A组）、后处理组（B组）和对照组（C组）,每组20例,各组术中均以0.15 μg/kg· min的速率静脉输注瑞芬太尼.A组患者于麻醉诱导前30 min静脉注射帕瑞昔布40 mg和右美托嘧啶0.2 μg/kg,B组于瑞芬太尼输注30 min后静脉注射帕瑞昔布40 mg和右美托嘧啶0.2μg/kg,C组患者输注等容量的生理盐水.评估术后15 min、30 min、1h、2h、6h、12 h、24h的VAS疼痛评分,记录血压、心率、手术时间、麻醉时间、瑞芬太尼用量、拔管时间、拔管后镇静评分以及镇痛药用量和恶心呕吐、寒颤等不良反应的发生情况.结果 A组术后6h内的VAS评分均小于C组（P＜0.05）,1h至6h的VAS评分小于B组（P＜0.05）;B组术后1h内的VAS评分小于C组,其余各时点与C组比较无明显差别（P＞0.05）.A、B、C三组术后24小时内芬太尼的用量分别为246.25±17.09μg、326.20±19.78μg、479.50±18.84μg,两两比较有统计学差异（P＜0.01）.与C组比较,A、B组VAS评分首次≥4的时间明显延长,追加镇痛药后VAS评分＜4的时间明显缩短,A组术后恶心呕吐的发生率明显降低（P＜0.05）.结论 术前或术中注射小剂量右美托嘧啶和帕瑞昔布能明显改善老年患者瑞芬太尼输注后的痛觉过敏,并减少术后恶心呕吐的发生率,预先给药比瑞芬太尼输注后给药效果更好.

Objective To investigate the impact of pre-treatment or post-treatment with dexmet- omidine and parecoxib on remifentanil-induced hyperalgesia in elderly patients. Methods Sixty elderly patients （ASA Ⅱ or Ⅲ） scheduled for elective laparoscopic cholecystectomy were randomized into three groups（n=20）, pre-treatment group （group A）, post-treatment group （group B） and control group （group C）. Intravenous infusions of 0.2 μg/kg dexmedetomidine and 40 mg parecoxib were given 30 min before induction in patients of group A or 30 min after remifentanil infusion in group B, while patients in group C were injected with saline, respectively. Surgery and anesthesia duration, time to extubation, sedation score, VAS pain score, usage of analgesics, and the incidences of adverse effects were recorded. Results The VAS scores both in group A and group B were significantly lower than that of group C after surgery （P〈0.05）. The postoperative usages of fentanyl in group A, B and C were 246.25 ±17.09 μg, 326.20±19.78 μg and 479.50±18.84 μg, with any two groups differentiating significantly （P〈0.01）. The need for additional analgesic in group A was later than that of group B and C, and faster pain relief was obtained in group A after using analgesics. Additionally, administration of dexmedetomidine combined with parecoxib also decreased the incidences of postoperative nausea and vomiting, with no significance between group A and B. Conclusion Preoperative or intraoperative injection of dexmedetomidine and pareeoxib can significantly alleviate remifentanil-induced hyperalgesia in elderly patients and can reduce the incidence of postoperative nausea and vomiting, better outcome gained when managing preoperatively.