右美托咪定不同使用方案对结肠癌瑞芬太尼全麻术后早期痛觉过敏的抑制作用

目的探究右美托咪定联合羟考酮和单纯使用右美托咪定两种方案对结肠癌瑞芬太尼全麻术后早期痛觉过敏的抑制作用,方法160例行腹腔镋下结肠癌根治术的患者按照随机数表法分为A、B、C、D四组,每组各40例。A组麻醉诱导使用右美托咪定,B组手术结束前使用羟考酮,C组麻醉诱导时使用右美托咪定、手术结束前使用羟考嗣,D组患者不采用额外措施,观察比较四组术中麻醉的常规指标、术后不同时间点的VAS评分、手术周围痛域、镇痛泵和曲马多使用次数及术后不良反应等情况。结果四组患者手术均顺利完成,手术时间、苏醒时间和拔管时间组间比较,差异无统计学意义(P>0.05)。A、B、C组患者术后TO、T1、T2的VAS评分均低于D组(P<0.05);C组术后T0的VAS评分低于A、B组(P<0.05),,A、B、C组患者术后TO、T1、T2切口周围的痛域高于D组(P<0.05);C组术后T0切口周围的痛域高于A、B组(P<0.05)。与D组比较,A、B组的首次镇痛泵按压时间延后(P<0.05),,A、B、C组24h内镇痛泵按压次数和曲马多使用次数均少于D组(P<0.05),C组24h内镇痛泵按压次数少于与A、B组(P<0.05)。首次镇痛泵按压时间与曲马多使用次数,A、B、C三组之间差异无统计学意义(P>0.05)。四组的不良反应发生率,差异均无统计学意义(P>0.05)结论右美托咪定联合羟考酮可有效预防瑞芬太尼导致的OIH现象,其镇痛效果优于单纯使用右美托咪定或羟考酮。

Objective To explore the inhibitory effects of dexmedetomidine combined with oxycodone and dexmedetomidine alone on early hyperalgesia after general anesthesia with remifentanil for colon cancer.Methods 160 patients undergoing laparoscopic radical resection of colon cancer were divided into four groups A,B,C,and D according to the random number table,with 40 cases in each group.In group A,dexmedetomidine was used for induction of anesthesia,group B was treated with oxycodone before the end of surgery,group C was treated with dexmedetomidine during induction of anesthesia,and oxycodone was used before the end of surgery,and patients in group D received no additional measures.To observe and compare the four groups of intraoperative anesthesia conventional indicators,VAS scores at different time points after surgery,peripheral pain areas,analgesic pump and tramadol use times,and postoperative adverse reactions.Results The operations of the four groups of patients were successfully completed,and there was no statistically significant difference in the operation time,wake—up time and extiibation time between the groups(P>0.05).The VAS scores of TO,T1 and T2 in groups A,B and C were lower than those in group D(P<0.05);the VAS scores of TO in group C were lower than those in groups A and B(P<0.05).The postoperative pain area around the TO,T1,and T2 incisions in groups A,B,and C was higher than that in group D(P<0.05);the postoperative pain area around TO incision in group C was higher than that in groups A and B(P<0.05).Compared with group D,the time of first analgesic pump compression in groups A and B was delayed(P<0.05).The number of analgesic pump compressions and tramadol use within 24 hours in groups A,B,and C were all less than those in group D(P<0.05),and the number of analgesic pump compressions in group C within 24 hours was less than that of groups A and B(P<0.05).There was no significant difference between the first analgesic pump pressing time and tramadol usage times between groups A,B,and C(P>0.05).There was no significant difference in the incidence of adverse reactions in the four groups(P>0.05).Conclusion Dexmedetomidine combined with oxycodone can effectively prevent the OIH phenomenon caused by remifentanil,and its analgesic effect is better than using dexmedetomidine or oxycodone alone.