不同剂量右美托咪定与小剂量氯胺酮预防瑞芬太尼复合麻醉后痛觉过敏的效果

The effects of different doses of dexmedetomidine and small doses of ketamine in preventing of hyperalgesia after remifentanil compound anesthesia

目的探讨不同剂量右美托咪定与小剂量氯胺酮预防瑞芬太尼复合麻醉后痛觉过敏的临床价值。方法收集在我院接受瑞芬太尼复合麻醉的患者,随机分为A组、B组和C组,各50例。A组和B组分别静脉给予0.4μg/kg、0.6μg/kg右美托咪定,C组给予氯胺酮0.8 mg/kg,其余麻醉方式相同。对比三组手术时间、拔管时间,术后30 min、1 h、2 h的VAS疼痛评分。结果 A组、B组、C组手术时间、拔管时间比较无明显差异(P>0.05)。A组、B组、C组术后30 min、1 h、2 h VAS疼痛评分比较有明显差异(P<0.05),B组优于A组和C组,而C组优于A组(P<0.05)。结论相对于0.4μg/kg右美托咪定与0.8 mg/kg氯胺酮,0.6μg/kg右美托咪定对预防瑞芬太尼复合麻醉后痛觉过敏疗效更为肯定。

Objective To explore the value of different doses of dexmedetomidine and small dose of ketamine in preventing of hyperalgesia after remifentanil anesthesia. Methods Patients receiving remifentanil anesthesia in our hospital were selected and randomly divided into group A, B and C, with 50 patients in each group. The patients in group A and B received intravenous of dexmedetomidine with 0.4 μg/kg, 0.6 μg/kg, the group C received 0.8 mg/kg ketamine, other anesthesia methods of the three groups were the same. The operation and extubation time, VAS scores in 30 min, 1 h and 2 h after the surgery among the three groups were compared. Results There was no significant difference in operation time and extubation time among the three groups （P〉0.05）. The differences of VAS scores in 30 min, 1 h, 2 h among group A, B and C were significantly difference （P〈0.05）, and VAS scores in group B were better than group A and C, while the VAS scores in group C were superior to group A （P〈0.05）. Conclusion Compared with 0.4 μg/kg medetomidine and 0.8 mg/kg ketamine, 0.6 μg/kg medetomidine could be fixed to prevent hyperalgesic effect of remifentanil composite anesthesia.