摘要
目的比较不同剂量右美托咪定与小剂量氯胺酮预防瑞芬太尼复合麻醉后痛觉过敏的效果。方法选取120例外伤手术患者作为研究对象,随机分为4组,氯胺酮组给予瑞芬太尼+0. 8 mg/kg氯胺酮,低剂量右美托咪定组给予瑞芬太尼+0. 4μg/kg右美托咪定,中剂量右美托咪定组给予瑞芬太尼+0. 6μg/kg右美托咪定,高剂量右美托咪定组给予瑞芬太尼+0. 8μg/kg右美托咪定,比较各组患者拔管时刻警觉/镇静评分(OAA/S评分)、手术时间、拔管时间以及术后0. 5、1、2 h的视觉模拟评分法(VAS)疼痛评分。结果与高剂量右美托咪定组相比,氯胺酮组、低剂量右美托咪定组、中剂量右美托咪定组拔管后OAA/S评分1级者占比显著更高、2级者占比显著更低(P <0. 01);各组患者手术时间、拔管时间比较,差异无统计学意义(P> 0. 05);中剂量右美托咪定组术后0. 5、1、2 h的VAS评分显著低于氯胺酮组、低剂量右美托咪定组(P <0. 05);中剂量右美托咪定组与高剂量右美托咪定组的术后0. 5、1、2 h的VAS评分比较,差异无统计学意义(P> 0. 05);高剂量右美托咪定组术后0. 5、1、2 h的VAS评分显著低于氯胺酮组、低剂量右美托咪定组(P <0. 05)。结论中等剂量右美托咪定或高剂量右美托咪定均可预防瑞芬太尼诱导的术后痛觉过敏,但应用中等剂量右美托咪定的患者拔管时刻OAA/S评分更优,麻醉恢复更快,安全性较高。
Objective To investigate the effect of different doses of dexmedetomidine and low dose ketamine on hyperalgesia after remifentanil combined anesthesia. Methods A total of 120 patients with traumatic surgery were randomly divided into four groups: ketamine group(remifentanil plus 0.8 mg/kg ketamine) and low dose dexmedetomidine group (remifentanil plus 0.4 μg/kg dexmedetomidine, medium dose dexmedetomidine group (remifentanil plus 0.6 μg/kg dexmedetomidine), and high dose dexmedetomidine group (remifentanil plus 0.8 μg/kg dexmedetomidine). The scores of Observer′s Assessment of Alertness/Sedation (OAA/S), the time of operation, the time of extubation and Visual Analogue Scores (VAS) at 0.5, 1, 2 h were compared in these groups. Results The proportion of OAA/S score with grade 1 after extubation was significantly increased, and those with grade 2 had lower ratio in ketamine group, low dose dexmedetomidine group, and medium dose dexmedetomidine group when compared to the high dose dexmedetomidine group( P <0.01). No significant differences in the operation time and extubation time between the two groups were observed( P >0.05). The VAS pain score at 0.5, 1 and 2 h decreased significantly in medium dose dexmedetomidine group when compared with the ketamine group and the low dose dexmedetomidine group( P <0.05), but showed no significant difference when compared to high dose dexmedetomidine group( P >0.05). Compared with ketamine group and low dose dexmedetomidine group, the VAS pain score at 0.5, 1 and 2 h in high dose dexmedetomidine group were significantly lower( P <0.05). ConclusionModerate dexamethasone or high-dose dexmedetomidine can be used to prevent remifentanil-induced postoperative hyperalgesia, but patients treated with moderate doses of dexmedetomidine have higher OAA/S scores, faster anesthesia recovery,and higher safety.
作者
李晓锋
LI Xiaofeng(Department of Anesthesiology, Second Hospital in Hanbin District of Ankang City, Ankang, Shaanxi, 725021)
出处
《实用临床医药杂志》
CAS
2019年第5期80-82,89,共4页
Journal of Clinical Medicine in Practice
基金
陕西省卫生厅科研基金项目(2014J25947)
