右美托咪定联合地佐辛或羟考酮对瑞芬太尼诱导的痛觉过敏的防治效果观察

Effect of dexmedetomidine combined with dezocine or oxycodone on remifentanil-induced hyperalgesia

目的探讨基于右美托咪定的不同联合用药干预措施对瑞芬太尼诱导的痛觉过敏(RIH)的预防作用。方法全麻腹腔镜下胆囊切除手术患者90例,按随机数字表法分为对照组、右美托咪定联合地佐辛组(地佐辛组)、右美托咪定联合羟考酮组(羟考酮组),每组30例。3组患者均给予咪达唑仑0.03 mg/kg、丙泊酚2 mg/kg、顺式阿曲库铵0.2 mg/kg、瑞芬太尼1μg/kg进行麻醉诱导。麻醉诱导前5 min,3组均静脉泵注右美托咪定0.7μg/kg,30 min内输注完毕。地佐辛组和羟考酮组在手术结束前30 min分别静脉注射地佐辛(0.1 mg/kg)或羟考酮(0.1 mg/kg),对照组静脉注射等体积生理盐水。记录各组术后30 min和1、6、12、24 h VAS评分以及术后30、60、90 min Ramsay评分,并观察追加镇痛药情况及不良反应发生率。结果地佐辛组和羟考酮组在术后各时间点的VAS评分均低于对照组(P<0.05);地佐辛组在术后30 min和1、12、24 h 4个时间点的VAS评分明显低于羟考酮组(P<0.05)。地佐辛组和羟考酮组术后各时间点Ramsay评分均低于对照组(P<0.05);地佐辛组与羟考酮组之间术后各时间点Ramsay评分差异无统计学意义(P>0.05)。地佐辛组、羟考酮组追加镇痛率低于对照组(P<0.05);地佐辛组与羟考酮组追加镇痛率差异无统计学意义(P>0.05)。地佐辛组和羟考酮组头晕、恶心呕吐发生率均高于对照组(P<0.05);羟考酮组头晕、恶心呕吐发生率高于地佐辛组(P<0.05)。结论与右美托咪定联合羟考酮相比,右美托咪定联合地佐辛能更有效缓解RIH,不良反应少,镇痛满意度高。

Objective To explore the preventive effect of different combined drug interventions based on dexmedetomidine on remifentanil-induced hyperalgesia(RIH).Methods A total of 90 patients undergoing laparoscopic cholecystectomy under general anesthesia were randomly divided into control group,dexmedetomidine combined with dezocine group(dezocine group),and dexmedetomidine combined with oxycodone group(oxycodone group),with 30 cases in each group.Anesthesia was induced with 0.03 mg/kg of midazolam,2 mg/kg of propofol,cisatracurium 0.2 mg/kg and 1μg/kg of remifentanil in all three groups.At 5 min before anesthesia induction,0.7 g/kg dexmedetomidine was injected intravenously in all three groups,and the infusion was completed within 30 min.Dezocine group and oxycodone group received intravenous dezocine(0.1 mg/kg)or oxycodone(0.1 mg/kg)30 min before the end of surgery,respectively.Normal saline of equal volume was injected intravenously in the control group.VAS scores at 30 min and 1,6,12,24 h after surgery and Ramsay scores at 30,60,90 min after surgery were recorded for each group,and the rate of supplementary analgesics and adverse reactions were observed.Results VAS scores of both dezocine group and oxycodone group were lower than that of the control group at each time point after operation(P<0.05).VAS scores at 30 min,1 h,12 h and 24 h after operation were significantly lower in the dezocine group than in the oxycodone group(P<0.05).Ramsay scores in both dezocine group and oxycodone group were lower than that in the control group(P<0.05).There was no statistically significant difference in Ramsay score between the dezocine group and the oxycodone group at each postoperative time point(P>0.05).The rate of supplementary analgesics in the dezocine group and oxycodone group was lower than that in the control group(P<0.05).There was no significant difference in the rate of supplementary analgesics between the dezocine group and the oxycodone group(P>0.05).The incidence of dizziness,nausea and vomiting in the dezocine group and the oxycodone group was higher than that in the control group(P<0.05).The incidence of dizziness,nausea and vomiting in the oxycodone group was higher than that in the dezocine group(P<0.05).Conclusions Compared with dexmedetomidine combined with oxycodone,dexmedetomidine combined with dezocine is more effective in relieving RIH,with fewer adverse reactions and higher analgesic satisfaction.