右美托咪定术中静脉推注剂量对达芬奇机器人经口腔前庭入路甲状腺切除患者瑞芬太尼诱导的输注后痛觉过敏的影响

Effect of intravenous infusion dose of dexmedetomidine during Da Vinci robot-assisted transoral thyroidectomy on remifentanilinduced postoperative hyperalgesia

目的:探讨右美托咪定术中静脉推注剂量对达芬奇机器人经口腔前庭入路甲状腺切除患者瑞芬太尼诱导的输注后痛觉过敏的影响。方法:选取2020年4月—2023年5月于空军军医大学第二附属医院行达芬奇机器人经口腔前庭入路甲状腺切除术的90例患者为研究对象,采用随机数表法将其分为A组(n=45)和B组(n=45),A组术中静脉推注0.3μg/(kg·h)的右美托咪定,B组术中静脉推注0.6μg/(kg·h)的右美托咪定。比较两组患者的血流动力学、苏醒和拔管时间、疼痛和痛觉过敏情况。结果:两组患者不同时点的心率(HR)、SpO_(2)和平均动脉压(MAP)的组内和组间交互比较,差异均具有统计学意义(P<0.05)。LSD-t检验结果显示,与本组T0时点比较,两组患者T1、T2时点的HR均升高(P<0.05);B组患者T1时点的MAP升高(P<0.05);两组患者T1、T2、T3时点的SpO_(2)均升高(P<0.05),但与B组相比,A组患者T1、T2、T3时点的HR、MAP、SpO_(2)差异无统计学意义(P>0.05)。与B组相比,A组苏醒和拔管时间更短(P<0.05),两组患者芬太尼用量差异无统计学意义(P>0.05)。两组患者不同时间点的视觉模拟评分法(VAS)评分组内比较,差异均具有统计学意义,但两组患者术后2 h、8 h、12 h、24 h VAS评分差异无统计学意义(P>0.05)。两组患者痛觉过敏发生率差异无统计学意义(P>0.05)。结论:达芬奇机器人经口腔前庭入路甲状腺切除患者瑞芬太尼诱导的输注后,术中静脉推注0.3μg/(kg·h)和0.6μg/(kg·h)的右美托咪定均可稳定血流动力学,减轻疼痛,减少痛觉过敏,但术中静脉推注0.3μg/(kg·h)的右美托咪定可缩短患者苏醒和拔管时间。

Objective:To explore the effect of different intravenous infusion doses of dexmedetomidine during Da Vinci robot-assisted transoral thyroidectomy on remifentanil-induced postoperative hyperalgesia.Methods:90 patients who underwent Da Vinci robot-assisted transoral thyroidectomy in the Second Affiliated Hospital of Air Force Medical University from April 2020 to May 2023 were selected and divided into the group A and group B using a random number table,with 45 cases in each group.Patients in the group A were given intravenous infusion of 0.3μg/(kg·h)dexmedetomidine and 0.6μg/(kg·h)to the group B.Hemodynamics,awakening and extubation time,pain degree,and hyperalgesia between the two groups of patients were compared.Results:Inter-and intra-group comparison of heart rate(HR),SpO_(2)and mean arterial pressure(MAP)at different time points showed significant difference.LSD-t test results showed that HR of the two groups increased at T1 and T2(P<0.05),MAP increased at T1 in group B(P<0.05),and SpO_(2)in the two groups increased at T1,T2,and T3(P<0.05).However,compared with the group B,the difference in levels of HR,MAP,and SpO_(2)of group A at T1,T2,and T3 were not statistically significant(P>0.05).Awakening and extubation time in the group A were shorter than those in the group B(P<0.05),and the difference in amount of fentanyl used in the two groups was not statistically significant(P>0.05).Intra-group comparison showed significant difference in the VAS score at different time points,but there was no statistically significant difference in VAS scores between the two groups at 2 h,8 h,12 h and 24 h after surgery(P>0.05).No significant difference in the incidence of pain hypersensitivity was found between the two groups(P>0.05).Conclusion:After remifentanil induced infusion in patients undergoing Da Vinci robot-assisted transoral thyroidectomy,intraoperative intravenous infusion of 0.3 and 0.6μg/(kg·h)dexmedetomidine dexmedetomidine could stabilize hemodynamics,alleviate pain,and lower pain hypersensitivity,but intravenous infusion of 0.3μg/(kg·h)dexmedetomidine could shorten patients’recovery and extubation time.