CAJ | 학술논문

目的：观察右美托咪定联合帕瑞昔布钠用于预防瑞芬太尼麻醉后痛觉过敏的效果及安全性。方法择期行腹腔镜胆囊切除手术的女性患者100例。按照数字表将患者分为四组：对照组（C 组）、帕瑞昔布钠组（P 组）、右美托咪定组（D 组）、右美托咪定联合帕瑞昔布钠组（DP 组）。患者入室后行常规监测，所有患者均行静脉麻醉，静脉泵注丙泊酚4～12 mg·kg－1·h－1和瑞芬太尼0.2μg· kg－1· min－1，P 组手术结束前30 min 静脉注射帕瑞昔布钠40 mg；D 组诱导后以0.6μg·kg－1·min－1的剂量静脉恒速泵注右美托咪定至手术结束前30 min；DP 组诱导后以0.6μg·kg－1·min－1的剂量静脉恒速泵注右美托咪定至手术结束前30 min 并注射帕瑞昔布钠40 mg。记录术后1、2、6、12、24 h 的 VAS 评分；以及术后发生躁动、寒颤、恶心呕吐和24 h 内追加镇痛药物的例数。结果与C 组比较，P 组、D 组、DP 组术后各时点 VAS 评分明显降低（P＜0.05），DP 组患者在术后各时点 VAS 评分明显低于 P 组和 D 组（P＜0.05）。D 组和 DP 组术后躁动和寒颤发生率明显低于 C 组（P＜0.05）。DP 组术后24 h 镇痛药物的追加明显低于 C 组、P 组和 D 组（P＜0.05）。结论麻醉诱导后以0.6μg·kg－1·min－1静脉恒速泵注右美托咪定至手术结束前30 min 并注射帕瑞昔布钠40 mg 能够减少瑞芬太尼停药后导致的痛觉过敏，并减少术后躁动和寒颤的发生率。
목적：관찰우미탁미정연합파서석포납용우예방서분태니마취후통각과민적효과급안전성。방법택기행복강경담낭절제수술적녀성환자100례。안조수자표장환자분위사조：대조조（C 조）、파서석포납조（P 조）、우미탁미정조（D 조）、우미탁미정연합파서석포납조（DP 조）。환자입실후행상규감측，소유환자균행정맥마취，정맥빙주병박분4～12 mg·kg－1·h－1화서분태니0.2μg· kg－1· min－1，P 조수술결속전30 min 정맥주사파서석포납40 mg；D 조유도후이0.6μg·kg－1·min－1적제량정맥항속빙주우미탁미정지수술결속전30 min；DP 조유도후이0.6μg·kg－1·min－1적제량정맥항속빙주우미탁미정지수술결속전30 min 병주사파서석포납40 mg。기록술후1、2、6、12、24 h 적 VAS 평분；이급술후발생조동、한전、악심구토화24 h 내추가진통약물적례수。결과여C 조비교，P 조、D 조、DP 조술후각시점 VAS 평분명현강저（P＜0.05），DP 조환자재술후각시점 VAS 평분명현저우 P 조화 D 조（P＜0.05）。D 조화 DP 조술후조동화한전발생솔명현저우 C 조（P＜0.05）。DP 조술후24 h 진통약물적추가명현저우 C 조、P 조화 D 조（P＜0.05）。결론마취유도후이0.6μg·kg－1·min－1정맥항속빙주우미탁미정지수술결속전30 min 병주사파서석포납40 mg 능구감소서분태니정약후도치적통각과민，병감소술후조동화한전적발생솔。
Objective To observe the preventive efficacy and safety of dexmedetomidine with parecoxib sodium on the patients with postoperative hyperalgesia induced by remifentanil. Methods A total of 100 female patients undergoing elective surgery under general anesthesia were as-signed into four groups according to the table of random number:the control group (group C),the parecoxib sodium group (group P),the dexmedetomidine group (group D)and the parecoxib sodium combined with the dexmedetomidine group (group DP).The vital signs were monitored and the total intravenous anesthesia was performed.All the patients were give intravenous injection of 0.2μg·kg-1 ·min-1 remifentanil and 4-12 mg·kg-1 ·h-1 propofol to maintain the anesthesia.Patients in group P were given 40 mg parecoxib sodium 30 minutes before the end of the operation.Patients in group D were give intravenous injection of 0.6μg·kg-1 ·min-1 dexmedetomidine consistently till 30 min before the end of the operation.Patients in group DP were given 0.6 μg·kg-1 ·min-1 till 30 min before the end of the operation and were given 40 mg parecoxib sodium.The VAS scores were re-corded at 1,2,6,12,24 hours.The cases of agitation,rigors,nausea and vomiting and increasing of analgesics were recorded.Results The postoperative VAS scores in group P,group D and group DP were significantly lower than group C(P <0.05).The postoperative VAS scores in group DP were significantly lower in group P and group D (P<0.05).Cases of agitation and rigors in group D and group DP were less than group C(P <0.05).The increasing of analgesics in group DP was much higher than other groups(P<0.05).Conclusion After induced,patients were given intravenous in-jection of 0.6 μg·kg-1 ·min-1 dexmedetoniding consistently till 30 min before the end of the opera-tion were given 40 mg parecoxib sodium can effectively prevent hyperalgesia after remifentanil anes-thesia without significant increase in revival time and obtain a better sedation.