右美托咪定对瑞芬太尼引起术后痛觉过敏的影响

发布时间：2018-04-01 19:19

本文选题：右美托咪定　切入点：瑞芬太尼　出处：《广东医学》2017年20期

【摘要】：目的观察右美托咪定对术中泵注瑞芬太尼引起的术后痛觉过敏的影响。方法选择60例择期行腹腔镜结肠癌根治术患者,ASAⅠ~Ⅱ级,随机分为右美托咪定组(DG组)和对照组(CG组),每组30例。麻醉诱导时DG组泵注负荷量右美托咪定1μg/kg,15 min后改为0.5μg/(kg·h)泵注维持,CG组泵注等容量生理盐水。记录术中丙泊酚和瑞芬太尼用量、拔管时间、拔管后1、2、3、6、12、24 h VAS评分、术后PCA首次按压时间与有效按压次数、围术期不同时间点的血浆P物质(SP)浓度及各种不良反应发生情况。结果 DG组术中丙泊酚用量少于CG组,拔管后不同时间点VAS评分DG组明显低于CG组(P0.05)。CG组术后PCA的首次按压时间较DG组缩短,有效按压次数明显多于DG组(P0.01)。两组患者的血浆SP浓度在术后不同时间点均较基础值升高(P0.05),且术后不同时间点DG组患者的血浆SP浓度均明显低于CG组患者(P0.05)。两组患者术后并发症发生率差异无统计学意义。结论右美托咪定可以降低介导疼痛传递的神经递质SP水平,抑制了SP介导的中枢敏化,减轻患者术后疼痛的程度,起到预防瑞芬太尼诱发术后痛觉过敏的作用。
[Abstract]:Objective to observe the effect of dexmetomidine on postoperative hyperalgesia induced by remifentanil. DG group and control group were randomly divided into control group (n = 30) and control group (n = 30). During anesthesia induction, the pump load of DG group was changed to 0.5 渭 g/(kg / h after 1 渭 g 路kg ~ (-1) 路kg ~ (-1) g 路kg ~ (-1) 路kg ~ (-1) min) to maintain the same volume of normal saline in CG group. The intraoperative propofol was recorded. Phenol and remifentanil, The time of extubation, the VAS score of 12 hours after extubation, the first time of PCA pressing and the number of effective compressions, the concentration of substance P in plasma at different time points of perioperative period and the occurrence of various adverse reactions in DG group were less than those in CG group during the operation, results the dosage of propofol during operation in DG group was less than that in CG group. The VAS score at different time points after extubation in DG group was significantly lower than that in CG group (P 0.05). The first pressing time of PCA in CG group was shorter than that in DG group. The number of effective compressions was significantly higher than that of DG group (P 0.01). The plasma SP concentration in both groups was significantly higher than that in the basic value at different time points after operation, and the plasma SP concentration in DG group was significantly lower than that in CG group at different time points. Conclusion dexmetomidine can reduce the level of neurotransmitter SP which mediates pain transmission. It inhibited SP mediated central sensitization, alleviated postoperative pain and prevented remifentanil induced hyperalgesia.
【作者单位】：暨南大学第二临床医学院、深圳市人民医院麻醉科;
【分类号】：R614

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