右美托咪定对腹腔镜胆囊切除术患者瑞芬太尼麻醉后痛觉过敏的影响

Influence of dexmetomidine on the hyperalgesia induced by remifentanil anesthesia in patients with laparoscopic cholecystectomy

目的 观察右美托咪定对腹腔镜胆囊切除术患者瑞芬太尼麻醉后痛觉过敏的影响.方法 选择2015年10月至2017年9月在河南中医药大学第三附属医院择期行腹腔镜胆囊切除术的患者98例,根据盲抽法将其分为对照组和观察组,每组49例.对照组术中采用瑞芬太尼维持麻醉,观察组术中采用右美托咪定＋瑞芬太尼维持麻醉.比较两组血流动力学指标、疼痛程度及不良反应.结果 观察组麻醉诱导后（T2）、气管插管时（T3）、拔管后（T4）平均动脉压、心率波动幅度小于对照组,差异有统计学意义（P〈0.05）;观察组苏醒后0.5、1.0、1.5 h视觉模拟评分法（VAS）评分低于对照组,差异有统计学意义（P〈0.05）;观察组术后不良反应发生率低于对照组,差异有统计学意义（P〈0.05）.结论 瑞芬太尼麻醉下腹腔镜胆囊切除术患者术中加用右美托咪定,可抑制痛觉过敏,改善血流动力学指标,且不增加不良反应发生率.

Objective To observe the effects of dexmetomidine on the hyperalgesia induced by remifentanil anesthesia in patients with laparoscopic cholecystectomy .Methods Ninety-eight patients who underwent laparoscopic cholecystectomy in the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from October 2015 to September 2017 were selected and were divided into control group and observation group according to blind selection method , with 49 cases in each group . Patients in control group were given remifentanil to maintain anesthesia , while patients in observation group were given dexmetomidine ＋remifentanil to maintain anesthesia .Hemodynamic indicators , pain degree and adverse reactions of the two groups were compared .Results Mean arterial pressure （ MAP） and fluctuation range of hear rate after anesthesia induction （ T2 ） , at tracheal intubation （ T3 ） and after extubation （ T4 ） in observation group were lower than those in control group , and the difference was statistically significant （ P〈0.05 ） .The visual analogue scale scores at 0.5, 1.0 and 1.5 h after regaining consciousness in observation group were lower than those in control group , and the difference was statistically significant （ P〈0.05 ） .The incidence of postoperative adverse reactions of observation group was lower than that of control group , and the difference was statistically significant （ P〈0.05 ） . Conclusions Add dexmedetomidine into remifentanide anesthesia for laparoscopic cholecystectomy can inhibit hyperalgesia , improve hemodynamic indicators , without increasing the incidence of adverse reactions.