脑电双频指数介导下右美托咪定预防瑞芬太尼痛觉过敏的最佳时机

Potimal timing of dexmedetomidine preventing remifentanil-induced hyperalgesia via bispectral index

目的探讨脑电双频指数(BIS)介导下右美托咪定预防瑞芬太尼痛觉过敏反应的最佳时机。方法择期行全子宫切除术的患者120例,采用随机数字表法分为A、B、C组,分别在麻醉诱导时(A组)、手术15min时(B组)、手术30min时(C组)给予右美托咪定0.6μg/(kg·h)至腹膜关完。监测3组患者的BIS至拔管后60min;监测3组患者入手术室时(T_1)、手术结束时(T_2)、拔除气管导管时(T_3)、拔管后10min(T_4)、拔管后30min(T_5)和拔管后60min(T_6)6个时点的动脉平均压(MAP)、心率(HR)、血氧饱和度(SpO2)及BIS值。比较不同时点的MAP、HR的组间和组内变化;比较不同时点的VAS痛觉评分;比较麻醉不良反应的发生例数。结果 3组患者T_2、T_3、T_4、T_5、T_65个时点的MAP、HR与T_1时组内比较,A组差异无统计学意义(P>0.05);B、C组的组内比较,差异均有统计学意义(均P<0.05)。A组患者在T_2、T_3、T_4、T_5、T_65个时点的MAP、HR与B、C组对应的时点比较,差异均有统计学意义(均P<0.05)。A组和B、C组患者拔管后在T_3、T_4、T_5、T_65个相对应时间点的VAS痛觉评分比较,差异均有统计学意义(均P<0.05)。A组和B、C组躁动发生率比较,差异均有统计学意义(均P<0.05)。结论行全子宫切除术的患者在麻醉诱导时即给予右美托咪定0.6μg/(kg·h)至腹膜关完,可以预防瑞芬太尼的痛觉过敏反应,而且麻醉不良反应少。

Objective To investigate the potimal timing of dexmedetomidine（Dex）preventing remifentanil-induced hyperalgesia via bispectral index.Methods This was a randomized,double-blind controlled study.One hundred and twenty patients undergoing abdominal hysterectomy were randomly divided into three groups（n=40each）：All patients received Dex 0.6μg/（kg·h）from induction of anesthesia（group A）,15min（group B）or 30min（group C）after injection skin to abdomen closed.BIS value,mean arterial pressure（MAP）,heart rate（HR）and SpO_2 were recorded before anesthesia induction（T_1）,at the beginning（T_2）and ending（T_3）of operation,immediately and 10,30,60 min after extubation（T_（4-6））.Visual analog scale（VAS）at the time point T_（4-6） and the occurrence of adverse reactions were also observed.Results There were no significant changes in MAP and HR at T_（2-6） as compared with the baseline values before operation（T_1）in group A（P〉0.05）,while the changes were significant in group B and C（P〈0.05）.Compared with group B and C,the values of MAP and HR at T_（2-6） in group A were significantly different（P〈0.05）.But there were no significant changes in group B and C（P〉0.05）.Compared with group B and C,VAS score at T_（3-6） and incidence of agitation was decreased in group A（P〈0.05）.Conclusion Intravenous injection of Dex 0.6μg/（kg·h）at the beginning of induction can reduce postoperative hyperalgesia in patients after remifentanil based anesthesia for patients undergoing abdominal hysterectomy.