中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2015年
4期
401-404
,共4页
田立东%张麟临%刘继强%王海云%王国林
田立東%張麟臨%劉繼彊%王海雲%王國林
전립동%장린림%류계강%왕해운%왕국림
右美托咪啶%布托啡诺%哌啶类%痛觉过敏%手术后并发症
右美託咪啶%佈託啡諾%哌啶類%痛覺過敏%手術後併髮癥
우미탁미정%포탁배낙%고정류%통각과민%수술후병발증
Dexmedetomidine%Butorphanol%Piperidines%Hyperalgesia%Postoperative complications
目的 评价布托啡诺复合右美托咪定对瑞芬太尼诱发术后痛觉过敏的影响.方法 择期行妇科腹腔镜手术患者120例,ASA分级Ⅰ或Ⅱ级,年龄20 ～ 64岁,体重45～ 88 kg,采用随机数字表法分为4组(n=30):对照组(C组)、布托啡诺组(B组)、右美托咪定组(D组)和右美托咪定+布托啡诺组(B+D组).C组切皮前即刻给予等容量生理盐水;D组于麻醉诱导前10 min时静脉输注右美托咪定1.0 μg/kg,然后以0.7 μg·kg-1·h-1的速率静脉输注至术毕;B组切皮前即刻静脉注射布托啡诺20 μg/kg;B+D组于麻醉诱导前10 min时静脉输注右美托咪定0.5 μg/kg,然后以0.5 ug· kg-1·h-1的速率静脉输注至术毕,切皮前即刻静脉注射布托啡诺15 μg/kg.静脉注射咪达唑仑、舒芬太尼、罗库溴铵和异丙酚诱导麻醉,气管插管后行机械通气,维持PETCO2 35～45 mmHg.静脉输注瑞芬太尼0.3 μg· kg-1·min-1和异丙酚4～6 mg·kg-1·h-1,间断静脉注射罗库溴铵维持麻醉,术中维持BIS值40～60.术后采用舒芬太尼行PCIA,维持VAS评分≤3分.分别于术后30和60 min、6、12、24和48 h时,记录舒芬太尼用量;记录术中心动过缓、低血压和术后恶心呕吐、眩晕、嗜睡的发生情况.结果 与C组比较,B组、D组和B+D组术后各时段舒芬太尼用量降低,恶心呕吐发生率均降低,B组眩晕和嗜睡的发生率升高,D组低血压和心动过缓的发生率升高(P＜0.05);B组、D组和B+D组组间术后各时段舒芬太尼用量比较差异无统计学意义(P＞0.05);与B组比较,B+D组眩晕和嗜睡的发生率降低(P＜0.05);与D组比较,B+D组低血压、心动过缓和嗜睡的发生率降低(P＜0.05).结论 布托啡诺复合右美托咪定减轻瑞芬太尼诱发术后痛觉过敏的效果优于两者单独应用.
目的 評價佈託啡諾複閤右美託咪定對瑞芬太尼誘髮術後痛覺過敏的影響.方法 擇期行婦科腹腔鏡手術患者120例,ASA分級Ⅰ或Ⅱ級,年齡20 ～ 64歲,體重45～ 88 kg,採用隨機數字錶法分為4組(n=30):對照組(C組)、佈託啡諾組(B組)、右美託咪定組(D組)和右美託咪定+佈託啡諾組(B+D組).C組切皮前即刻給予等容量生理鹽水;D組于痳醉誘導前10 min時靜脈輸註右美託咪定1.0 μg/kg,然後以0.7 μg·kg-1·h-1的速率靜脈輸註至術畢;B組切皮前即刻靜脈註射佈託啡諾20 μg/kg;B+D組于痳醉誘導前10 min時靜脈輸註右美託咪定0.5 μg/kg,然後以0.5 ug· kg-1·h-1的速率靜脈輸註至術畢,切皮前即刻靜脈註射佈託啡諾15 μg/kg.靜脈註射咪達唑崙、舒芬太尼、囉庫溴銨和異丙酚誘導痳醉,氣管插管後行機械通氣,維持PETCO2 35～45 mmHg.靜脈輸註瑞芬太尼0.3 μg· kg-1·min-1和異丙酚4～6 mg·kg-1·h-1,間斷靜脈註射囉庫溴銨維持痳醉,術中維持BIS值40～60.術後採用舒芬太尼行PCIA,維持VAS評分≤3分.分彆于術後30和60 min、6、12、24和48 h時,記錄舒芬太尼用量;記錄術中心動過緩、低血壓和術後噁心嘔吐、眩暈、嗜睡的髮生情況.結果 與C組比較,B組、D組和B+D組術後各時段舒芬太尼用量降低,噁心嘔吐髮生率均降低,B組眩暈和嗜睡的髮生率升高,D組低血壓和心動過緩的髮生率升高(P＜0.05);B組、D組和B+D組組間術後各時段舒芬太尼用量比較差異無統計學意義(P＞0.05);與B組比較,B+D組眩暈和嗜睡的髮生率降低(P＜0.05);與D組比較,B+D組低血壓、心動過緩和嗜睡的髮生率降低(P＜0.05).結論 佈託啡諾複閤右美託咪定減輕瑞芬太尼誘髮術後痛覺過敏的效果優于兩者單獨應用.
목적 평개포탁배낙복합우미탁미정대서분태니유발술후통각과민적영향.방법 택기행부과복강경수술환자120례,ASA분급Ⅰ혹Ⅱ급,년령20 ～ 64세,체중45～ 88 kg,채용수궤수자표법분위4조(n=30):대조조(C조)、포탁배낙조(B조)、우미탁미정조(D조)화우미탁미정+포탁배낙조(B+D조).C조절피전즉각급여등용량생리염수;D조우마취유도전10 min시정맥수주우미탁미정1.0 μg/kg,연후이0.7 μg·kg-1·h-1적속솔정맥수주지술필;B조절피전즉각정맥주사포탁배낙20 μg/kg;B+D조우마취유도전10 min시정맥수주우미탁미정0.5 μg/kg,연후이0.5 ug· kg-1·h-1적속솔정맥수주지술필,절피전즉각정맥주사포탁배낙15 μg/kg.정맥주사미체서륜、서분태니、라고추안화이병분유도마취,기관삽관후행궤계통기,유지PETCO2 35～45 mmHg.정맥수주서분태니0.3 μg· kg-1·min-1화이병분4～6 mg·kg-1·h-1,간단정맥주사라고추안유지마취,술중유지BIS치40～60.술후채용서분태니행PCIA,유지VAS평분≤3분.분별우술후30화60 min、6、12、24화48 h시,기록서분태니용량;기록술중심동과완、저혈압화술후악심구토、현훈、기수적발생정황.결과 여C조비교,B조、D조화B+D조술후각시단서분태니용량강저,악심구토발생솔균강저,B조현훈화기수적발생솔승고,D조저혈압화심동과완적발생솔승고(P＜0.05);B조、D조화B+D조조간술후각시단서분태니용량비교차이무통계학의의(P＞0.05);여B조비교,B+D조현훈화기수적발생솔강저(P＜0.05);여D조비교,B+D조저혈압、심동과완화기수적발생솔강저(P＜0.05).결론 포탁배낙복합우미탁미정감경서분태니유발술후통각과민적효과우우량자단독응용.
Objective To evaluate the effect of butorphanol combined with dexmedetomidine on postoperative hyperalgesia induced by remifentanil in patients.Methods One hundred and twenty patients,of ASA physical status Ⅰ or],aged 20-64 yr,weighing 45-88 kg,undergoing elective gynecological laparoscopic surgery,were randomly allocated into 4 groups (n =30 each) using a random number table:control group (group C),butorphanol group (group B),dexmedetomidine group (group D) and dexmedetomidine + butorphanol group (group B+D).In group D,dexmedetomidine 1.0 μg/kg was infused at 10 min before induction of anesthesia,followed by continuous infusion at 0.7 μg·kg 1·h-1 until the end of operation.In group C,the equal volume of normal saline was given instead before skin incision.In group B,butorphanol 20 μg/kg was injected immediately before skin incision.In group B+D,dexmedetomidine 0.5 μg/kg was infused at 10 min before induction of anesthesia,followed by continuous infusion at 0.5 μg· kg-1 · h-1 until the end of operation,and butorphanol 15 μg/kg was injected immediately before skin incision.Anesthesia is induced with iv midazolam 0.05 mg/kg,sufentanyl 0.2-0.3 μg/kg,rocuronium 0.7 mg/kg and propofol 2.0 mg/kg.After tracheal intubation,all the patients are mechanically ventilated,and PETCO2 was maintained at 35-45 mmHg.Anesthesia was maintained with iv infusion of remifentanil 0.3 μg · kg-1 · min 1 and propofol 4-6 mg·kg 1·h-1 and intermittent iv boluses of rocuronium 0.3 mg/kg.BIS value was maintained at 40-60.Patient-controlled intravenous analgesia (PCIA) with sufentanil was used after operation,and VAS score was maintained ≤ 3.At 30 and 60 min and 6,12,24 and 48 h after operation,the sufentanil consumption was recorded.The development of bradycardia and hypotension during operation and postoperative nausea and vomiting,dizziness and somnolence was recorded.Results Compared with group C,the sufentanil consumption and incidence of nausea and vomiting were significantly decreased in B,D and B+D groups,the incidence of dizziness and somnolence was increased in group B,and the incidence of bradycardia and hypotension was increased in group D.There was no significant difference in sufentanil consumption between B,D and B+D groups.The incidence of dizziness and somnolence was significantly lower in group B + D than in group B.The incidence of bradycardia,hypotension and somnolence was significantly lower in group B + D than in group D.Conclusion Butorphanol combined with dexmedetomidine provides better efficacy than either alone in reducing postoperative hyperalgesia induced by remifentanil in patients.
