右美托咪定对瑞芬太尼麻醉患者痛觉过敏缓解的有效性

Effectiveness of dexmedetomidine to alleviate hyperalgesia of remifentanilanesthesia patients

目的 探讨右美托咪定对瑞芬太尼麻醉患者痛觉过敏缓解的有效性。方法 选取2014年12月~2016年4月期间择期行腹腔镜全子宫切除术的84例患者,随机分为观察组和对照组,每组各42例,2组均于术中静脉输注瑞芬太尼、丙泊酚和吸入七氟醚维持麻醉。观察组于手术结束前40 min予以0.6μg/kg的右美托咪定（加入100 m L 0.9%氯化钠溶液中,10 min内缓慢滴注）;对照组患者予以相同容量0.9%氯化钠溶液。分别采用视觉模拟评分法（visual analogue scale,VAS）和舒适评分量表（bruggrmann comfort scale,BCS）对2组患者的不同时间节点的术后疼痛程度以及舒适程度进行评估,以及对2组患者的不良反应发生情况进行客观比较。结果 2组患者的VAS评分在术后1 h（T1）、4 h（T2）和24 h（T3）时差异显著,且观察组患者VAS评分明显更优于对照组,差异有统计学意义（P〈0.05）;2组的BCS评分在T1、T2时比较,差异有统计学意义（P〈0.05）,但T3差异无统计学意义;同时,观察组的不良反应发生情况更低于对照组,差异有统计学意义（P〈0.05）。结论 右美托咪定减轻和防止瑞芬太尼麻醉患者痛觉过敏和不良反应的发生,且有效提高了患者术后的镇痛效果。

Objective To investigate the efficacy of dexmedetomidine in reduce of hyperalgesia in patien with remifentanil anesthesia. Methods 84 patients scheduled for laparoscopic hysterectomy from December 2014 to April 2016 were selected and randomly divided into two groups： he observation group and the control group, 42 cases in each group, two groups were intravenous infusion of remifentanil, propofol and inhaled evoflurane to maintain anesthesia. In the observation group, 0. 6 （jug/kg of dexmedetomidine was given 40 minutes before the end of the operation （adding to 100 mL 0. 9% sodium chloride solution, infusion within 10 minutes） ,the control group was given the same volume of 0. 9% sodium chloride olution. The visual analogue scale （VAS） and the bruggrmann comfort scale （BCS） were used to evaluate the postoperative pain and comfort of the two groups of patients at different time points, and compare the incidence of adverse events between the two groups. Results T h e V A S s c o r e s of the t w o groups were significantly different at 1 h （ Tj） , 4 h （ T2） and 24 h （T3） , and the VAS score of the observation group was significant better than that of he control group, the difference was statistically significant （P 〈0. 05） ,the BCS scores of two group were compared at Tj and T2, the difference was tatistically significant （P 〈 0. 05 ） , but there was no significant difference between the two groups at T3. The incidence of adverse reactions in the bservation group was lower than that in the control group, the difference was statistically significant （ P 〈 0. 05 ）. Conclusion D e x m e d e t o m i d i n e c a n elieve and prevent the incidence of hyperalgesia and adverse reactions in patients with remifentanil anesthesia, and improve the analgesic effect of ostoperative patients.