摘要
目的探讨术前单次给予右美托咪定对全麻腹腔镜下全子宫切除术患者瑞芬太尼诱导的痛觉敏化的影响。方法选取我院2017年3月—2018年3月择期行全麻下经腹子宫切除术患者90例为研究对象,按是否应用右美托咪定及其用药方法分为A组、B组和对照组,每组30例。A组气管插管后,切开皮肤(切皮)前给予右美托咪定;B组气管插管后至拔管前持续泵注右美托咪定;对照组气管插管后,切皮前静脉注射0.9%生理盐水。比较3组术后躁动发生和躁动后应用镇痛药情况,测定术前和术后不同时间点的痛阈、视觉模拟评分(VAS)、Ramsay评分。结果对照组T1(术后0.5 h)、T2(术后1 h)时痛阈值低于T0时(术前),T3时(拔管12 h)、T4时(拔管24 h)痛阈值高于T0时(P<0.05)。A组T1～T3时,B组T1～T4时痛阈值高于T0时(P<0.05);A组T1、T2时,B组T1～T3时痛阈值高于对照组(P<0.05)。B组在T4时痛阈值高于A组(P<0.05)。A组和B组术后躁动发生率和躁动后用镇痛药均低于对照组(P<0.05);A组和B组术后不同时刻VAS评分均低于对照组,Ramsay评分均高于对照组(P<0.05)。但A组和B组间比较差异无统计学意义(P>0.05)。3组不良反应发生率比较差异无统计学意义(P>0.05)。结论术前单次给予右美托咪定能够改善瑞芬太尼诱导的痛觉敏化。
Objective To investigate effect of preoperative Dexmedetomidine administration for one time on pain-sensitization induced by Remifentanil in patients undergoing laparoscopic complete hysterectomy under general anesthesia. Methods A total of 90 patients undergoing selective abdominal hysterectomy under general anesthesia during March 2017 and March 2018 were divided group A, group B and control group according to whether or not using Dexmedetomidine and administration methods ( n =30 in each group). In group A, Dexmedetomidine was given before skin incision and after tracheal cannula;in group B, Dexmedetomidine was continuously pumped after tracheal intubation and before the time of extubation;in control group, 0.9% physiological saline was injected intravenously before skin incision and after tracheal cannula. Among three groups, incidence rates of postoperative restlessness and analgesics use conditions for restlessness were compared, and pain threshold, visual analogue scales (VAS) scores and Ramsay scores at different times before and after operation were detected. Results In control group, values of pain threshold at T1 (in postoperative 0.5 h extubation) and T2 (in 1 h after extubation) were significantly lower than that at T0, while values of pain threshold at T3 (in 12 h after extubation) and T4 (in 24 h after extubation) were significantly higher than that at T0 (before operation)( P <0.05). Values of pain threshold at T1-T3 in group A and at T1-T4 in group B were significantly higher than those at T0 ( P <0.05). Values of pain threshold at T1-T2 in group A and at T1-T3 in group B were significantly higher than those in control group ( P <0.05). At T4, value of pain threshold in group B was significantly higher than that in group A ( P <0.05). Incidence rates of postoperative restlessness and analgesics use doses for restlessness in group A and B were significantly lower than those in control group ( P <0.05). In group A and group B, VAS scores at postoperative different times were significantly lower, while Ramsay scores were significantly higher than those in control group ( P <0.05), but there were no significant differences between group A and B ( P >0.05). There were no significant differences in incidence rates of adverse reactions among three groups ( P >0.05). Conclusion Preoperative Dexmedetomidine administration for one time may improve pain-sensitization induced by Remifentanil in patients undergoing laparoscopic complete hysterectomy under general anesthesia.
作者
孙立
高明龙
马丽
马亚群
刘永哲
SUN Li;GAO Ming-long;MA Li;MA Ya-qun;LIU Yong-zhe(Department of Anaesthesiology, the Seventh Medical Center, General Hospital of PLA, Beijing 100700, China)
出处
《解放军医药杂志》
CAS
2019年第5期96-100,共5页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
基金
北京市科技计划课题(Z161100000116074)
北京市科技计划课题(Z171100000417035)
关键词
麻醉
全身
右美托咪定
瑞芬太尼
痛觉敏化
Anesthesia, whole body
Dexmedetomidine
Remifentanil
Pain-sensitization
