摘要
目的观察右美托咪定复合地佐辛超前镇痛对后腹膜腔镜手术患者瑞芬太尼输注后痛觉过敏的影响。方法选择90例泌尿外科择期行后腹膜腔镜手术患者，随机分为对照组（C组）、右美托咪定组（Y组）和右美托咪定复合地佐辛组（Y＋D组），每组各30例。Y组在麻醉诱导前15min，静脉泵注右美托咪啶0．5μg／kg；Y＋D组在麻醉诱导前15min，给予右美托咪啶0．5μg／kg，于手术开始前5min给予地佐辛0．1mg／kg；C组在相同时间点给予等容积的生理盐水。手术结束患者出手术室时，给予病人自控静脉镇痛（PCIA）。比较3组患者的手术时间、瑞芬太尼和丙泊酚的用量、苏醒时间、拔除气管导管时间、不同时间点的VAS评分、术后不良事件的发生以及镇痛药物的追加情况。结果各组患者均未见明显呼吸抑制，苏醒时间及拔管时间也未见明显延长。Y组和Y＋D组术后各时间点VAS评分均显著低于C组（P〈0．05）。与Y组比较，Y＋D组术后12h及24h的VAS评分明显降低（P〈0．05）。与C组比较，Y组和Y＋D组术后躁动及寒战的发生率明显降低，术后24h内镇痛药物的追加次数显著降低（P〈0．05）。结论右美托咪定复合地佐辛对预防后腹膜腔镜手术患者瑞芬太尼输注后痛觉过敏有明显效果，而且术后寒战、躁动等不良反应的发生率明显降低。
Objective To observe the effects of dexmedetomidine combined with dezocine on the hyperalgesia in patients after remifentanil infusion in the retroperitoneal laparoseopy surgery. Methods A total of 90 patients who were scheduled to undergo retroperitoneal laparoscopic surgery were randomly divided into 3 groups （ n = 30） ： a control group （ Group C）, a dexmedetomidine group （ Group Y） and a dexmedetomidine ＋ dezocine group （ Group Y ＋ D）. Group Y was intravenously infused with 0.5 μg/kg of dexmedetomidine 15 min before induction of anesthesia. Group Y ＋ D was intravenously infused with 0.5 μg/kg of dexmedetomidine 15 min before induction of anesthesia, followed by administration of 0.1 mg/kg of dezocine 5 min before operation. Meanwhile, Group C was given the equal volume of normal saline. After surgery, the patients were provided with patient- controlled intravenous analgesia （PCIA）. The groups were compared for the duration of surgery, the doses of propofol and remifentanil, recovery and extubation times, VAS scores, the incidence of adverse events and the time of additional anesthetic administration. Results Neither obvious respiratory inhibition nor extended recovery and extubation times were found in each group. Groups Y and Y ＋ D showed remarkably lower VAS scores than Group C at each time points after surgery （ P 〈 0.05 ）. Meanwhile, compared with Group Y, significant lower VAS scores were found in Group Y ＋ D 12 h and 24 h after surgery （ P 〈 0.05 ）. Groups Y and Y ＋ D presented markedly reduced incidences of postoperative restlessness and shivering as well as times of additional anesthetic administration 24 h after surgery, in comparison with Group C （ P 〈 0.05 ）. Conclusions The combined therapy of dexme- detomidine and dezocine is effective for the prevention of postoperative hyperalgesia in patients after remifentanil infusion after retroperitoneal laparoscopic surgery, with a reduced incidence of adverse reactions.
出处
《徐州医学院学报》
CAS
2016年第11期709-712,共4页
Acta Academiae Medicinae Xuzhou
基金
国家自然科学基金（31100801,81200858）
徐州医学院附属医院课题（2013042）
关键词
右美托咪定
地佐辛
后腹膜腔镜手术
瑞芬太尼
痛觉过敏
dexmedetomidine
dezocine
retroperitoneal laparoscopic surgery
remifentanil
hyperalgesia
