右美托咪定联合曲马多预防瑞芬太尼麻醉后痛觉过敏的效果

Effect of the dexmedetomidine combined with tramadol on preventing post-anesthetic hyperalgesia induced by remifentanil

目的：观察右美托咪定联合曲马多用于预防瑞芬太尼麻醉后痛觉过敏的效果及安全性。方法：将80例择期行腹腔镜手术的患者随机分为对照组（D组）、曲马多组（Q组）、右美托咪定组（Y组）、右美托咪定联合曲马多组（L组）,各20例。记录不同阶段的心率（HR）、平均动脉压（MAP）、苏醒时间、拔管时间、患者术前和术后各时间点进行机械刺激疼痛试验时的VAS评分、术后24 h内追加镇痛药物的患者例数、患者术后不良反应的发生情况。结果：D组与Q组患者在拔除气管导管时、拔除气管导管后5 min、10 min时间点的HR和MAP均显著高于Y组与L组（P〈0.01）,Y组与L组患者的差异均无统计学意义（P〉0.05）。L组患者苏醒时间和拔管时间均长于D组和Q组（P〈0.05）,而Y组拔管时间亦长于D组（P〈0.05）。D组患者在术后各时间点的VAS评分均显著高于术前（P〈0.01）,Q组、Y组和L组患者在术后各时间点的VAS评分均低于D组（P〈0.01）,L组患者在术后各时间点的VAS评分均显著低于Q组与Y组（P〈0.01）。L组患者术后24 h镇痛药物的追加均显著低于D组、Q组和Y组（P〈0.01）,4组患者术后24 h恶心呕吐以及寒颤的发生率差异均无统计学意义（P〉0.05）,Y组和L组患者术后躁动发生均显著低于D组和Q组（P〈0.05~P〈0.01）。结论：右美托咪定联合曲马多能够较好地预防瑞芬太尼麻醉后引起的痛觉过敏,并能够提供良好的镇静、镇痛,使拔管期血流动力学平稳,不增加术后恶心呕吐等不良反应。

Objective：To observe the effects and safety of the dexmedetomidine combined with tramadol on preventing post-anesthetic hyperalgesia induced by remifentanil. Methods：Eighty patients scheduled by operation were randomly divided into the control group （Group D） ,tramadol group（ Group Q）, dexmedetomidine group（ Group Y） and dexmedetomidine combined with tramadol group（ Group L） （ 20 cases each group）. The HR and MAP in different stages,awakening time,trachea extubation time,VAS pain scores before and after operation, number of patients treated with supplementary analgesic drugs after 24 h of operation and adverse reactions were recorded. Results：The HR and MAP in group D and group Q at trachea extubation, after 5 and 10 min of extubation were significantly higher than those in group Y and group L （P 〈 0.01 ）, the differences of HR and MAP in Y and group L were not statistically significant （P 〉 0.05 ）. The awakening time in group L were longer than those in group D and group Q （P 〈 0.05 ）, the trachea extubation time in group Y were longer than that in group D （ P 〈 0.05 ）. The VAS scores in group D at all postoperative time points were significantly higher than that before treatment（ P 〈 0.01 ）. The VAS scores in group Q, Y and L at all postoperative time points were significantly less than in group D（P 〈0.01 ）. The VAS scores in group L at all postoperative time points were significantly less than in group Q and L （P 〈 0.01 ）. The supplementary analgesic drugs in L group at postoperative 24 h was significantly less than that in group D, Q and Y （P〈0.01）, the differences of the incidence of nausea, vomiting and chills between four groups at postoperative 24 h were not statistically significant（P 〉0.05 ）, the incidence of restless in group Y and group L were significantly less than that in group D and group Q（ P 〈 0.05 to P 〈 0.01 ）. Conclusions ：The dexmedetomidine combined with tramadol can prevent post-anesthetic hyperalgesia induced by remifentanil, and provide good sedation and analgesia, stable hemodynamics during extubation, and do not increase the postoperative nausea and vomiting.