右美托咪定术毕前注射预防瑞芬太尼麻醉后急性反应性疼痛的效果

Effects of dexmedetomidine injection in the prevention of reaction acute pain after anesthesia with remifentanil

目的 观察术毕前静脉注射右美托咪定对瑞芬太尼麻醉后急性疼痛的预防效果.方法 拟行腹腔镜手术的患者90例,随机分为右美托咪定组（A组）和生理盐水组（B组）,所有患者术中静脉恒速输注瑞芬太尼0.2 mg· kg-1·min-1维持麻醉,A组于手术结束前30 min泵注右美托咪定,B组则以同等速率泵注生理盐水.观察两组手术时间、术后苏醒时间、拔管时间、VAS评分、追加镇痛药物以及不良反应.结果 A组手术时间、术后苏醒时间、拔管时间和B组差异均无统计学意义（P＞0.05）;两组拔管即刻至术后8h的VAS评分均逐渐升高,术后8h至术后24 h均逐渐降低,且A组拔管即刻、术后4、8、12、24 h的VAS均较B组低（P＜0.05）;A组术后有5例患者追加曲马朵,B组有15例,且前者不良反应发生率为4.4％,后者高达22.2％,差异具有统计学意义（P＜0.05）.结论 手术结束前注射右美托咪定可在瑞芬太尼麻醉后起到预防急性疼痛作用,减轻术后疼痛程度.

Objective To observe the effects of intraoperative injection of dexmedetomidine in the prevention of reactive acute pain after remifentanil anesthesia during laparoscopy.Methods Ninety patients with laparoscopic surgery were randomly divided into experimental group （group A） and control group （group B）.Remifentanil 0.2 mg· kg 1 · min 1 was pumpted for analgesia.The patients in group A were given infusion of dexmedetomidine at 30 min before the end of operation,while group B with the same volume normal saline.The operation time, postoperative recovery time, extuhation time, hospitalization time, postoperative VAS, postoperative supplementary analgesic drugs and adverse reactions were observed and compared.Results There were no significant differences in operation time, postoperative recovery time and extubation time between the two groups （P〉 0.05） , but the hospitalization time in group A was significantly shorter than that in group B （P〈0.05）.VAS was gradually increased from the immediate extubation time to postoperative 8 h, and gradually decreased from postoperative 8 h to postoperative 24 h.VAS at the immediate extubation time, postoperative 4 h, postoperative 8 h, postoperative 12 h, and postoperative 24 h in group A were significantly lower than those in group B （P 〈 0.05）.There were 5 cases with additional tramadol after surgery in group A, 15 cases in group B and the adverse reactions rate was 4.4% in group A, and 22.2% in group B, with statistical differences （P 〈0.05）.Conclusion Intravenous infusion of dexmedetomidine at 30 min before the end of operation can prevent reactive acute pain after remifentanil anesthesia, and reduce the level of postoperative pain.