右美托咪定防治瑞芬太尼诱发术后痛觉过敏的临床效果
Clinical effectiveness comparison of dexmedetomidine for preventing and treating postoperative remifentanil-induced hyperalgesia
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摘要: 目的：探讨右美托咪定（dexmedetomidine，Dex）用于防治瑞芬太尼诱发的痛觉过敏（remifentanil-induced hyperalgesia，RIH）的有效性及安全性。方法：选择ASA Ⅰ~Ⅱ级择期行食管癌根治术病人80例，随机分为4组：低剂量Dex组（LD组），中剂量Dex组（MD组），高剂量Dex组（HD组）以及对照组（C组），每组20例。麻醉诱导前，LD组泵注Dex 0.25 μg/kg，10 min后继以0.25 μg·kg-1·h-1维持至手术结束前30 min；MD组泵注Dex 0.50 μg/kg，10 min后继以0.50 μg·kg-1·h-1维持至手术结束前30 min；HD组泵注Dex 1.00 μg/kg，10 min后继以1.00 μg·kg-1·h-1维持至手术结束前30 min；C组给予相应剂量的0.9%氯化钠注射液。记录拔管后改良的警觉-镇静（OAA/S）评分；拔管后10 min、30 min、1 h、2 h、6 h、12 h和24 h的视觉模拟（VAS）评分（安静时和活动状态下）；术后24 h内PCA泵所用药物总量以及术后不良反应的发生情况。结果：拔管后LD、MD和HD组VAS评分明显低于C组（P<0.01），且呈现剂量依赖性。LD、MD、HD组病人术后24 h内镇痛药物总量和不良反应发生率明显少于C组（P<0.01）。结论：围手术期应用中等剂量的Dex可安全有效地改善病人术后疼痛及防治术中输注大剂量的瑞芬太尼所诱发的痛觉过敏，减少并发症，提高病人舒适度。Abstract: Objective:To observe the efficacy and safety of dexmedetomidine(Dex) in preventing and treating remifentanil-induced hyperalgesia(RIH).Methods:Eighty patients(stage ASA Ⅰ to Ⅱ) scheduled by radical resection of esophageal carcinoma were randomly divided into the low dose of Dex group(group LD),medium dose of Dex group(group MD),high dose of Dex group(group HD) and control group(group C) (20 cases each group).Before the induction of anaesthesia,group LD,MD and HD were treated with 0.25 μg/kg,0.50 μg/kg and 1.00 μg/kg of Dex by intravenous infusion for 10 min,then with 0.25 μg·kg-1·h-1,0.50 μg·kg-1·h-1 and 1.0 μg·kg-1·h-1 of Dex till 30 min before the end of the operation,respectively.The C group were treated with the same volume 0.9% sodium chloride injection.The score of improved OAA/S after extubation,and the scores of VAS 10 min,30 min,1 h,2 h,6 h,12 h and 24 h after extubation in four groups were recorded.The total drug mount in PCA and incidence rate of postoperative adverse reactions in four groups 24 h after operation were recorded.Results:The scores of VAS in group LD,MD and HD after extubation were significantly lower than that in group C(P<0.01),which was dose-dependent.The total drug mount in PCA and incidence rates of postoperative adverse reactions in group LD,MD and HD after 24 h of operation were significantly less than those in group C(P<0.01).Conclusions:Intraoperative infusion of medium dose of Dex can safely and effectively relieve postoperative pain,attenuate high-dose remifentanil-induced hyperalgesia,reduce the complication and improve the satisfaction of patients.
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Key words:
- hyperalgesia /
- dexmedetomidine /
- remifentanil /
- radical resection of esophageal carcinoma
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