氟比洛芬酯复合右美托咪定对瑞芬太尼麻醉后痛觉过敏的影响

发布时间：2018-01-25 03:55

  本文关键词： 氟比洛芬酯 右美托咪定 瑞芬太尼 痛觉过敏　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:瑞芬太尼因具有起效快、药效强、可控性高、重复和持续输注无蓄积等理想麻醉药物的诸多优点,临床应用普遍。但由于其独特的超短效代谢特性,高剂量或者长时间应用可使病人产生痛觉过敏。氟比洛芬酯和右美托咪定分别是常用的镇痛、镇静药物,二者防止痛觉过敏的机制不同,期待联合用药发挥协同作用并降低不良反应的发生率。目的:观察氟比洛芬酯和右美托咪定联合应用对瑞芬太尼麻醉后痛觉过敏的效果及影响。方法:选择ASA分级Ⅰ或Ⅱ级择期行甲状腺癌根治术的病人120例,使用计算机生成的随机数字表分成四组(n=30)即对照组:C组;实验组:F组,D组,F+D组。术前和术后0.5h、1h用Von Frey Hair纤毛机械刺激针分别测量患者的痛阈值。C组病人手术开始时静脉注射等容量的0.9%的氯化钠溶液;F组病人麻醉诱导前10分钟时静脉给予氟比洛芬酯2mg/kg;D组病人麻醉诱导时静脉给予右美托咪定1μg/kg(匀速输注时间设定30分钟);F+D组病人麻醉诱导前10分钟时静脉给予氟比洛芬酯1mg/kg,并在麻醉诱导时,开始静脉给予右美托咪定0.5μg/kg(匀速输注时间设定30分钟)。静脉输注瑞芬太尼0.20μg·kg-1·min-1,根据Narcotrend 37-64调整丙泊酚用量。术毕停药,送入PACU。结果:四组病人的年龄、BMI、性别比、ASA分级、麻醉时间、拔管时间、术中低血压的发生率比较差异无统计学意义(P0.05);同C组比较,F、D、F+D组患者术后0.5h、1h后手术部位与非手术部位皮肤痛阈值下降的发生率明显降低(P0.05),F组术后恶心呕吐的发生率升高(P0.05),D组术中心动过缓(HR45次/min)的发生率明显升高(P0.05)。F、D、F+D三组患者术后0.5h、1h后手术部位与非手术部位皮肤痛阈值下降的发生率之间比较差异无统计学意义(P0.05)。与F组比较,F+D组术后恶心呕吐的发生率降低(P0.05);与D组比较,F+D组术中心动过缓(HR45次/min)的发生率明显降低(P0.05)。结论:麻醉诱导前10分钟时静脉给予氟比洛芬酯1mg/kg,并在麻醉诱导时,静脉给予右美托咪定0.5μg/kg(匀速输注时间设定30分钟),可有效防止瑞芬太尼麻醉后产生的痛觉过敏,不影响拔管时间,且降低麻醉药物不良反应,临床上值得推荐。
[Abstract]:Background: remifentanil has rapid onset, high efficacy, high controllability, repeated and continuous infusion of non ideal anesthetic advantages accumulation, clinical application of common. But because of its unique ultra short acting metabolic properties, high dose or long time application can make the patient produces hyperalgesia. Flurbiprofen and right dexmedetomidine is commonly used analgesic, sedative drugs, two mechanism to prevent hyperalgesia, look forward to the combination synergistic effect and reduce the incidence of adverse reaction. Objective: To observe the effect of flurbiprofen axetil and dexmedetomidine combined application of hyperalgesia after remifentanil anesthesia and its effect. Methods: ASA grade I or II undergoing resection of thyroid cancer patients 120 cases, randomly divided into four groups using a computer-generated (n=30): control group: C group; experimental group: F group, D group, F+D group. The preoperative and postoperative 0 .5h, 1H Von Frey Hair cilia mechanical stimulation pain threshold needle were measured in group.C patients, surgical patients with Sodium Chloride Solution 0.9% intravenous injection capacity at the beginning; 10 minutes before induction of intravenous flurbiprofen axetil 2mg/kg group F patients during induction of anesthesia; intravenous dexmedetomidine anesthesia 1 g/kg patients (D group constant infusion time set 30 minutes); 10 minutes before induction of intravenous flurbiprofen axetil 1mg/kg group F+D anesthesia, and during anesthesia induction, start intravenous dexmedetomidine 0.5 g/kg (constant infusion time set 30 minutes). Intravenous infusion of remifentanil 0.20 G - kg-1 - min-1, according to Narcotrend 37-64 to adjust the dosage of propofol. Postoperative withdrawal into the PACU. results: four groups of patient's age, sex ratio, BMI, ASA grade, anesthesia time, extubation time, there was no significant difference in the incidence of intraoperative hypotension (P0.05); group C ratio 杈，

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