右美托咪定对术后吗啡自控镇痛的影响

目的观察右美托咪定对术后吗啡自控镇痛的影响。方法择期拟行全麻下直肠癌根治术患者40例随机均分为两组:D组诱导前10min静注右美托咪定1μg/kg,继以0.2μg.kg-1.h-1泵注至手术结束前30min;C组输注等量生理盐水。术后实施吗啡患者自控镇痛:背景输注吗啡3mg/h,PCA吗啡1mg/10min。记录术后2、6、12和24h的VAS疼痛评分及24-h吗啡总用量;检测麻醉前、术后2h和术后24h血浆皮质醇浓度。结果 D组术后VAS疼痛评分均明显低于C组(P<0.05或P<0.01);D组24-h吗啡消耗量明显少于C组(P<0.05)。D组术后2h和术后24h血浆皮质醇浓度低于C组(P<0.01)。结论术中持续泵注右美托咪定可有效增加术后吗啡自控镇痛效果,减少吗啡用量。

Effects of dexmedetomidine on postoperative morphine analgesia

Objective To investigate the effects of dexmedetomidine on postoperative morphine analgesia.Methods Forty patients undergoing redical resection of rectal cancer were equally randomized into two groups.The patients in group D were injected dexmedetomidine 1 μg/kg at 10 min before anesthesia induction,which was followed by infusion of dexmedetomidine 0.2 μg· kg-1·h-1 during operation and those in group C were given normal saline infusion as the controls.At the end of surgery,the patients of both groups received patient-controlled intravenous analgesia(PCIA) with morphine 3 mg/h(PCA dose 1 mg/10 min).The VAS pain scores were assessed at 2,6,12 and 24 h after surgery.The morphine consumption within 24 hours was calculated.Plasma concentration of cortisol was measured before anesthesia,at 2 h and 24 h after extubation.Results The VAS pain scores at 2,6,12,24 h during morphine analgesia were lower in group D than those in group C(P<0.05 or P<0.01).The 24-h morphine consumption was less in group D than that in group C(P<0.05).Plasma concentrations of cortisol at 2 h and 24 h after extubation were lower in group D than those in group C(P<0.01).Conclusion Infusion of dexmedetomidine 0.2 μg·kg-1·h-1 during operation can enhance analgesic effect of morphine PCIA and reduce the requirement of morphine.