右美托咪定和氯胺酮预防瑞芬太尼麻醉后痛觉过敏效果的比较

Comparison of Preventive Effects of Dexmedetomidine and Ketamine on Remifentanil-induced Postanesthetic Hyperalgesia

关键词:  右美托咪定  氯胺酮  瑞芬太尼  痛觉过敏

Key words:  dexmedetomidine  ketamine  remifentanil  hyperalgesia

摘要:

目的 比较右美托咪定(dexmedetomidine，DEX)和氯胺酮缓解瑞芬太尼麻醉后痛觉过敏的效果。方法 择期经腹全子宫切除术患者90例，随机分为对照组、DEX组和氯胺酮组。麻醉维持均采用瑞芬太尼0.4 mg·kg^-1·min^-1，吸入七氟醚。手术结束前30 min 3组分别给予生理盐水、DEX 1 mg·kg^-1和氯胺酮0.8 mg·kg^-1。记录3组患者拔管和苏醒时间，哌替啶使用人数及用量和不良反应的发生情况。分别于苏醒后2 h内和苏醒后4，8，12，24，48 h进行VAS评分。结果 苏醒后2 h内对照组VAS评分显著高于DEX组和氯胺酮组(P<0.05)，苏醒后4~48 h差异无统计学意义(P>0.05)，DEX组和氯胺酮组比较VAS评分差异无统计学意义；对照组要求镇痛人数和哌替啶用量显著大于DEX组和氯胺酮组(P<0.05)，DEX组和氯胺酮组间比较差异无统计学意义；氯胺酮组有3例出现复视，1例出现幻觉。结论 DEX和氯胺酮预防瑞芬太尼麻醉后痛觉过敏的效果确切且差别不明显。

Abstract:

OBJECTIVE To compare the preventive effects of dexmedetomidine and ketamine on remifentanil-induced postanesthetic hyperalgesia. METHODS Ninety patients undergoing elective total abdominal hysterectomy were randomly divided into three groups: control group, dexmedetomidine group and ketamine group. In all groups, anesthesia was maintained with remifentanil 0.4 mg·kg^-1·min^-1 in combination with sevoflurane. The same volume of saline, dexmedetomidine 1 mg·kg^-1 or ketamine 0.8 mg·kg^-1 were injected intravenously in the three groups respectively 30 min before skin closure. VAS scores were recorded within 2 h and at 4, 8, 12, 24 and 48 h after awaking. The amount of pethidine consumed and postoperative side effects were recorded. The extubation and awaking time were also recorded. RESULTS The amount of pethidine consumed was smaller wihin 2 h and 48 h after awaking and VAS scores were significantly lower within 2 h after awaking in group dexmedetomidine and ketamine than the control group. There was no significant difference between dexmedetomidine group and ketamine group. Three patients experienced diplopia and one had hallucination. CONCLUSION Both dexmedetomidine and ketamine have significant preventive effects on hyperalgesia induced by remifentanil but there are no significant differences between them.