CAJ | 학술논문

目的：观察右美托咪定联合曲马多用于预防瑞芬太尼麻醉后痛觉过敏效果及不良反应。方法选择70例妇科择期全麻手术的患者，随机分为2组：A组：全麻插管后静脉泵注右美托咪定1μg·kg -1，10min后改为0．4μg·kg -1·h-1至手术结束前30 min停药，缝皮前静注曲马多1 mg · kg -1；B组：术中泵注等量生理盐水，缝皮前静注曲马多1．5 mg · kg -1。记录所有患者的手术时间、苏醒时间、苏醒室停留时间。于拔管后即刻及术后20，40和60 min对患者进行Ramsay镇静程度评级，并于拔管后即刻、术后30，60和90 min对患者进行疼痛（VAS）评分。结果 A 组患者术后早期镇静评分明显高于B组（P＜0．05），2组患者术后VAS评分，差异无统计学意义（P＞0．05），A 组患者术后恶心、呕吐、寒战的发生率低于B组（P＜0．05）。结论右美托咪定联合曲马多可有效预防瑞芬太尼麻醉后痛觉过敏，且不明显增加复苏时间，获得良好的术后镇静，两者合用可减少曲马多用量，减少术后恶心呕吐、寒战的发生。
목적：관찰우미탁미정연합곡마다용우예방서분태니마취후통각과민효과급불량반응。방법선택70례부과택기전마수술적환자，수궤분위2조：A조：전마삽관후정맥빙주우미탁미정1μg·kg -1，10min후개위0．4μg·kg -1·h-1지수술결속전30 min정약，봉피전정주곡마다1 mg · kg -1；B조：술중빙주등량생리염수，봉피전정주곡마다1．5 mg · kg -1。기록소유환자적수술시간、소성시간、소성실정류시간。우발관후즉각급술후20，40화60 min대환자진행Ramsay진정정도평급，병우발관후즉각、술후30，60화90 min대환자진행동통（VAS）평분。결과 A 조환자술후조기진정평분명현고우B조（P＜0．05），2조환자술후VAS평분，차이무통계학의의（P＞0．05），A 조환자술후악심、구토、한전적발생솔저우B조（P＜0．05）。결론우미탁미정연합곡마다가유효예방서분태니마취후통각과민，차불명현증가복소시간，획득량호적술후진정，량자합용가감소곡마다용량，감소술후악심구토、한전적발생。
Objective To observe the preventive efficacy and safety of dexmedetomidine with tramadol on the patients with postoper-ative hyperalgesia induced by remifentanil .M ethods 70 patients ASA (Ⅰ-Ⅱ) undergoing elective surgery under general anesthe-sia were randomly assigned into two groups :The patients in group A were given intravenous injection of 1 μg · kg -1 · h-1 with mini-pump for ten minutes after the intubation ,then received intravenous injection of 0 .4 μg · kg -1 · h-1 consistently till 30 min before the end of the operation ,and received intravenous injection of tramadol 1 mg · kg -1 before the suturing .The patients in group B were given intravenous injection of the normal saline with the same dose and rate at the same time during the operation , and received intravenous injection of tramadol 1 .5 mg · kg -1 before the suturing .The operation time ,recovery time ,and the time stay in PACU were recorded .Adverse effects ,VAS and Ramsay scores were also recorded .Results Compared with group A , VAS score had no significant difference in group B (P>0 .05) ,Ramsay scores was significantly lower in group B early after opera-tion (P<0 .05) ,the incidence of patients with postoperative nausea and vomiting ,shiver was higher in group B(P<0 .05) .Con-clusion Dexmedetomidine combined with tramadol can effectively prevent hyperalgesia after remifentanil anesthesia without signif-icant increase in revival time ,and obtain a better sedation .