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

Dexmedetomidine Combined with Tramadol Preventing Remifentanil- induced Hyperalgesia

目的探讨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效果。方法选取2012年9月—2013年9月济南市第三人民医院行妇科手术全麻的子宫肌瘤患者92例,按照Doll's临床病例随机表分为试验组(46例)和对照组(46例)。试验组联合应用右美托咪定和曲马多,对照组单独应用曲马多。记录患者术后10 min、术后30 min、术后60 min时的心率和平均动脉压;记录患者术后即刻、术后20 min、术后40 min、术后60 min时的镇静程度评分;记录患者术后即刻、术后30 min、术后60 min、术后90 min时的疼痛视觉模拟评分法(VAS)评分;观察两组患者术后不良反应发生情况及不良反应发生率。结果两组患者的年龄,体质量,手术时间,瑞芬太尼剂量比较,差异均无统计学意义(P>0.05)。术后10 min时两组患者心率和平均动脉压比较,差异无统计学意义(P>0.05);试验组术后30 min、术后60 min时的心率和平均动脉压低于对照组(P<0.05)。两组患者术后30 min时的心率和平均动脉压高于术后60 min时(P<0.05)。试验组术后即刻、术后20 min、术后40 min、术后60 min时镇静程度评分高于对照组;两组患者术后即刻、术后20 min、术后40 min时镇静程度评分均高于术后60 min时(P<0.05)。试验组术后即刻、术后30 min、术后60 min、术后90 min时VAS评分均低于对照组(P<0.05);两组患者术后即刻、术后30min、术后60 min时VAS评分均高于术后90 min时(P<0.05)。试验组患者术后不良反应发生率为15.2%(7/46),低于对照组的41.3%(19/46)(P<0.05)。结论右美托咪定联合曲马多可以有效预防瑞芬太尼麻醉后痛觉过敏症状,减少术后并发症的发生,为临床应用提供了参考依据。

Objective To investigate the clinical effects of dexmedetomidine combined with tramadol in prevention of remifentanil- induced hyperalgesia. Methods From September 2012 to September 2013,in department of gynecologic surgery of Ji＇nan Third People＇s Hospital,92 uterine fibroid patients who had general anesthesia were divided,according to Doll＇s Clinical Cases,into groups study,control,46 in each. The control group were given only tramadol,the study group given tramadol combined with dexmedetomidine. Recording heart rate（ HR）,mean arterial pressure（ MAP） at minutes 10,30,60 after operation,scores of degree of sedation at instance,at minutes 20,40,60 after operation and pain scores（ VAS） at instance,at minutes 30,60,90 after operation,and observed postoperative adverse reaction rate. Results There was no significant difference in age,weight,operative time,remifentanil dose between 2 groups（ P 0. 05）,in HR,MAP at minutes 10 after operation（ P 0. 05）. The HR and MAP were lower in study group than in control group at minutes 30,60（ P 0. 05）,higher at minutes 30 than at minutes 60 after operation in 2 groups（ P 0. 05）. The score of degree of sedation was higher in study group than in control group at instance,at minutes 20,40,60 after operation,and higher at instance,at minutes 20,40 than at minutes 60 in 2 groups（ P 0. 05）. The VAS score was lower in study group than in control group at instance,at minutes 30,60,90 after operation（ P 0. 05）,higher at instance,at minutes 30,60 than at minutes 90 in 2 groups（ P 0. 05）. The postoperative adverse reaction rate was 15. 2%（ 7 /46） in study group,lower than in control group（ 41. 3%,19 /46）（ P 0. 05）. Conclusion Dexmedetomidine combined with tramadol can effectively prevent fentanyl- induced hyperalgesia,and reduce the occurrence of postoperative complications.