右美托咪定对瑞芬太尼复合全麻术后舒芬太尼自控镇痛效果的影响

目的评价右美托咪定对瑞芬太尼复合麻醉患者术后舒芬太尼静脉自控镇痛效果的影响。方法择期行腹腔镜肠癌切除术成年患者60例,随机分为右美托咪啶组(D组)和对照组(C组),各30例。D组诱导前静脉予右美托咪定负荷量1μg/kg,并以0.3μg/(kg·h)维持至术毕,C组为空白对照组。两组术后接镇痛泵,行舒芬太尼PCIA。记录患者定向力恢复时(Ta)、接泵后1 h(Tb)、3 h(Tc)、6 h(Td)、12 h(Te)、24 h(Tf)的VAS和BCS评分;记录术后24 h的PCA总按压次数及舒芬太尼总用量;记录术后恶心、呕吐、寒颤、呼吸抑制的发生情况。结果Ta、Tb时,D组患者VAS评分低于C组(p<0.05),D组BCS评分高于C组(p<0.05);D组术后24 h舒芬太尼用量和PCA按压次数少于C组(p<0.05);D组恶心、呕吐、寒颤的发生率少于C组(p<0.05)。结论右美托咪定1 ug/kg负荷剂量麻醉前给予和0.3 ug/(kg·h)持续维持,能减轻患者瑞芬太尼麻醉苏醒后早期的术后疼痛,减少术后自控镇痛舒芬太尼用量及术后恶心、呕吐、寒颤等不良反应的发生。

THE EFFECT OF DEXMEDETOMIDINE ON POSTOPERATIVE PAIN OF REMIFENTANIL ANESTHESIA IN PATIENTS RECEIVING PATIENT- CONTROLLED SUFENTANIL

Objective To investigate the effect of dexmedetomidine （Dex） on postoperative pain of remifentanil an- esthesia in patients receiving patient-controlled snfentanil. Method Sixty patients （ASA Ⅰ or Ⅱ ） undergoing selective lapa- roscopic colorectal operation were randomly divided into 2 groups ： Dex group （ group Dex, n = 30） and control group （ group C ,n =30）. Patients in Dex group were received Dex lμg/kg loading dose by pumped infusion 15 minutes before anesthesia and 0.3 μg/kg,/h to maintain by the operation finished, and control group were received normal saline. All patients were al- lowed to use a patient-controlled infusion analgesia （PCIA） device of sufentanil after operation finished. VAS score and BCS score were recorded at orientation recovery time and 1,3, 6, 12 and 24h after the beginning of PCIA. Cumulative sufentanil consumption and PCA pressing times 24 hours after the PCIA were recorded. The incidence of postoperative nausea, vomi- ting, shivering and respiratory depression was recorded. Result Group Dex had lower VAS score and bighter BCS score at the time of orientation recovery and 1 h after the beginning of PCIA compared with group C （p 〈0. 05 ） ; Cumulative sufentani consumption and PCA pressing times 24 hours after the PCIA in group Dex was obviously decreased （p 〈 0. 05 ） ; The inci- dence of early （up to 24 h） postoperative nausea, vomiting and shivering in Dex group were significantly decreased （p 〈 0105 ）. Conclusion Dexmedetomidine with a standardized （1 μg/kg） loading dose before anesthesia and 0.3 μg/kg/h to maintain until the operation finished （given by pumped infusion） can relieve the extent of acute postoperative pain, reduce postoperative sufentanil consumption and the incidence of postoperative nausea, vomiting and shivering.