急性升主动脉夹层撕裂患者右美托咪定复合吗啡的镇痛效果

Analgesic efficacy of dexmedetomidine combined with morphine in patients with acute ascending aortic dissection

目的评价急性升主动脉夹层撕裂患者右美托咪定复合吗啡的镇痛效果。方法急性升主动脉夹层撕裂患者60例，年龄31～60岁，BMI 21～32 kg/m2，性别不限，ASA分级Ⅱ或Ⅲ级，采用随机数字表法，将其分为2组（n＝30）：吗啡组（M组）和右美托咪定复合吗啡组（DM组）。2组均采用美托洛尔和硝普钠控制心率和血压，均肌肉注射吗啡10 mg，DM组注射吗啡后经10 min静脉输注右美托咪定负荷剂量0.5 μg/kg，随后以0.5 μg·kg－1·h－1的速率静脉输注24 h；2组当VAS评分〉3分或患者烦躁时肌肉注射吗啡0.1～0.2 mg/kg。分别于治疗前、治疗后5、10、20、30、50 min和1、3、5、7、9、12、18、24 h时记录BIS值，记录治疗期间美托洛尔、硝普钠、吗啡的用量、心动过缓、低血压、呼吸抑制和低氧血症的发生情况。结果与M组比较，DM组治疗期间BIS值、美托洛尔、硝普钠和吗啡的用量降低（P〈0.05），心动过缓、低血压、呼吸抑制和低-3时MWT降低，TWL缩短，脊髓铁含量升高（P〈0.05）；与I组和R组比较，I＋R组T1-3时MWT降低，TWL缩短，脊髓铁含量升高（P〈0.05）。结论瑞芬太尼诱发切口痛大鼠痛觉过敏的形成可能与脊髓铁含量升高有关。

Objective To evaluate the analgesic efficacy of dexmedetomidine combined with mor- phine in the patients with acute ascending aortic dissection. Methods Sixty patients of both sexes with a- cute ascending aortic dissection, aged 31-60 yr, with body mass index of 21-32 kg/m2, of American So- ciety of Anesthesiologists physical status 11 or HI , were randomly divided into 2 groups （n= 30 each） using a random number table： morphine group （ group M） and dexmedetomidine combined with morphine group （group DM）. Metoprolol and nitroprusside were used to control the heart rate and blood pressure, and mor- phine 10 mg was injected intramuscularly in the two groups. In group DM, dexmedetomidine was infused in a loading dose of 0. 5μg/kg over 10 min, followed by 24 b infusion of 0. 5 μg ·kg-1· h-1. When the visu- al analogue scale score 〉 3 or the patients were agitated, morphine 0. 1-0. 2 mg/kg was injected intramus-cularly. The bispectral index values were recorded before treatment and at 5, 10, 20, 30 and 50 min, and 1, 3, 5, 7, 9, 12, 18 and 24 h after treatment. The total amount of metoprolol, nitroprusside and morphine consumed, and development of bradycardia, hypotension, respiratory depression and hypoxemia were recorded during the period of treatment. Results Compared with group M, the bispectral index value and consumption of metoprolol, nitroprusside and morphine were significantly decreased （P〈0. 05） , and no significant change was found in the incidence of bradyeardia, hypotension, respiratory depression and hypoxemia in group DM （P〉 0. 05）. Conclusion Dexmedetomidine combined with morphine provides good analgesic efficacy in the patients with acute ascending aortic dissection.