右美托咪定预注射对乳腺癌术后舒芬太尼静脉自控镇痛的影响

目的观察麻醉诱导前预注射右美托咪定对乳腺癌术后舒芬太尼静脉自控镇痛（PCIA）的影响。方法择期行乳腺癌根治术，自愿行PCIA治疗的患者60例，随机均分为2组：分别在麻醉诱导前20min缓慢静脉注射（10min）右美托咪定1．0μg·kg^-1（D组）或等容积生理盐水（C组）。术毕患者进入麻醉恢复室静脉缓慢注射舒芬太尼0．1μg·kg^-1作为负荷量，之后接镇痛泵行PCIA，给予枸橼酸舒芬太尼0．04μg·kg^-1·h^-1＋托烷司琼4mg静脉自控镇痛泵。记录PCIA开始后1、2、6、12和24h的视觉模拟评分（VAS）、Ramsy镇静评分（RSS）；记录术后24h内镇痛泵总按压次数、有效按压次数和二者比值（D／D比值）、镇痛药物用量，以及恶心、呕吐和寒战等发生情况。结果PCIA后2、6、12h时点2组VAS评分D组明显低于C组（P〈0．05），但术后各时间点RSS评分2组差异无统计学意义（P〉0．05）。术后24h内D组镇痛泵总按压次数、有效按压次数和D／D比值、镇痛药物用量，以及恶心／呕吐、眩晕和寒战的发生率明显低于C组（P〈0．05或P〈0．01）。结论麻醉诱导前预注射右美托眯定可缓解乳腺癌术后疼痛程度，减少镇痛药物的使用次数和用量，并降低术后恶心呕吐、眩晕、寒战等不良反应发生率。

Effects of dexmedetomidine preinjection on the patient - controlled intravenous analgesia after breast cancer operation

Objective To observe the effects of dexmedetomidine preinjection on the patient - controlled intravenous analgesia （PCIA） after breast cancer operation. Methods Sixty patients undergoing selective breast cancer surgery and voluntarily agreeing PCIA, were randomly divided into 2 groups ： patients in D group received 1.0 μg·kg^-1 dexmedetomidine and C group received same volume of normal saline by infusion over 20 min before anesthesia induction. After operation, all patients received a loading dose of sufentanil （0.1 μg·kg^-1 ） in postanesthesia care unit, and then received PCIA （ sufentanil 0.04 μg·kg^-1·h^ - 1 ＋ tropisetron hydrochloride 4 mg）. VAS and RSS were recorded at 1,2, 6, 12, and 24 h after the beginning of PCIA. The total times and effective times, demand/delivery （D/D） of pressing PCIA, total use of anesthetics, and adverse reactions within 24 h after the beginning of PCIA were recorded. Results Compaerd with C group, VSA in D group was lower （P 〈 0.05 ） at 2, 6, and 12 h after the beginning of PCIA. However, there was no significant difference in RSS between the two groups （ P 〉 0.05 ） at 1, 2, 6, 12, and 24 h after the beginning of PCIA. Compared with C group, The total times and effective times, demand/delivery （D/D） of pressing PCIA, accumulated dose of anesthetics, and the incidence of adverse reactions within 24 h after the beginning of PCIA in D group was significantly lower （ P 〈 0.05 or P 〈 0.01 ）. Conclusion Dexmedetomidine preinjection before anesthesia induction can relieve pain degree after breast cancer operation, reduce the use of analgesic drugs, and reduce the postoperative inci- dence of adverse reactions.