右美托咪啶对唤醒麻醉下脑功能区手术唤醒质量和术后痛觉过敏的影响

Effects of dexmedetomidine on quality of wake-up and postoperative hyperalgesia in eloquent brain area surgery under awake anesthesia

目的评价右美托咪啶(dexmedetomidine,DEX)对唤醒麻醉下脑功能区手术唤醒质量和术后痛觉过敏的影响。方法择期拟行脑功能区肿瘤切除术病人45例,随机分为3组:丙泊酚复合瑞芬太尼组(R组)、DEX复合丙泊酚与瑞芬太尼组(D组)、生理盐水复合丙泊酚与瑞芬太尼对照组(C组)。记录术前、术后24、48、72 h的机械痛阈值以及术后72 h内的不良反应,并进行统计学分析。结果D组在术后各时间点痛阈值均明显高于R组及C组(P<0.05);而R组与C组在术后各时间点痛阈值差异无统计学意义(P>0.05)。3组间疼痛视觉模拟评分(visual analogue scale,VAS)及头晕头痛发生率差异均无统计学意义(P>0.05)。结论DEX用于唤醒麻醉下脑功能区手术不影响唤醒质量,且可抑制病人术后机械痛阈值降低,预防发生痛觉过敏。

Objective To observe the effects of dexmedetomidine(Dex)on quality of wake-up and postoperative hyperalgesia in eloquent brain area surgery underawake anesthesia.Methods Resection of eloquent brain area tumors were performed in 45 patients,who were randomly divided into three groups:propofol combined with remifentanil group(group R),Dex combined with propofol and remifentanil group(group D)and normal saline combined with propofol and remifentanil group(group C).Mechanical pain thresholds before the operation,and 24,48 and 72 h after the operation,and adverse reactions within 72 h after the operation were recorded and analyzed statistically.Results Mechanical pain thresholds in group D were obviously higher than those in group R and group C in every time point after the operation(P<0.05),while there was no significant difference in mechanical pain thresholds at every time point after the operation between group R and group C(P>0.05).Moreover,no significant difference was found in visual analogue scale(VAS)scores and the incidence rate of adverse reactions between the three groups(P>0.05).Conclusion Dex can increase postoperative mechanical pain threshold and prevent postoperative hyperalgesia without affecting the quality of wake-up in eloquent brain area surgery under awake anesthesia.