CAJ | 학술논문

目的:探索不同剂量右美托咪定联合超低剂量纳洛酮对瑞芬太尼诱发的术后痛觉过敏的效果.方法:将80例ASAⅠ~Ⅱ级的择期行鼻内镜鼻窦手术女性患者采用随机数字表法随机分为4组,对照组瑞芬太尼组(R组),瑞芬太尼 + 不同剂量右美托咪定 + 超低剂量纳洛酮组(RDN1组 ~ RDN3组),观察记录患者术后30 min、1、2、4、8、12、24 h的疼痛视觉模拟评分,术后第一疼痛时间、镇痛泵有效按压次数、芬太尼使用量和不良反应发生情况. 结果:任意时间点平均VAS得分R组 > RDN1组 > RDN2组 > RDN3组,R组与其他3组比较差异有统计学意义,RDN2组和RDN3组在观察的任何时间点均无统计学差异. RDN1组和RDN2组在第一疼痛时间、术后1 h按压次数上无统计学差异,RDN2组和RDN3组在术后24 h按压次数上无统计学差异,芬太尼用量3组无统计学差异,但均低于R组. 结论:右美托咪定联合超低剂量纳洛酮能明显改善瑞芬太尼导致的术后痛觉过敏,其效果随右美托咪定剂量的增加而升高,且这种增高对急性疼痛更敏感.
목적:탐색불동제량우미탁미정연합초저제량납락동대서분태니유발적술후통각과민적효과.방법:장80례ASAⅠ~Ⅱ급적택기행비내경비두수술녀성환자채용수궤수자표법수궤분위4조,대조조서분태니조(R조),서분태니 + 불동제량우미탁미정 + 초저제량납락동조(RDN1조 ~ RDN3조),관찰기록환자술후30 min、1、2、4、8、12、24 h적동통시각모의평분,술후제일동통시간、진통빙유효안압차수、분태니사용량화불량반응발생정황. 결과:임의시간점평균VAS득분R조 > RDN1조 > RDN2조 > RDN3조,R조여기타3조비교차이유통계학의의,RDN2조화RDN3조재관찰적임하시간점균무통계학차이. RDN1조화RDN2조재제일동통시간、 술후1 h안압차수상무통계학차이,RDN2조화RDN3조재술후24 h안압차수상무통계학차이,분태니용량3조무통계학차이,단균저우R조. 결론:우미탁미정연합초저제량납락동능명현개선서분태니도치적술후통각과민,기효과수우미탁미정제량적증가이승고,차저충증고대급성동통경민감.
Obejective To explore the effect of combined use of dexmedetomidine and ultra-low dose naloxone on postoperative hyperalgesia induced by remifentanil. Method 80 ASA gradeⅠ-Ⅱ female patients who were scheduled to perform endoscopic sinus surgery (ESS) were randomly divided into four groups: purely remifentanil group (group R) and remifentanil plus different dosage dexmedetomidine and ultra-low dose naloxone group (group RDN1 ~ RDN3). Then the postoperative VAS on 30 min, 1 h, 2 h, 4 h, 8 h, 12 h and 24 h together with the firstpostoperative pain time , PCA press numbers , fentanyl usage and adverse reaction rate were recorded and evaluated. Results Average VAS of group R are higher than other groups in all 7 time points at the adjusted significant level of 0.0083, and group R > group RDN1 > group RDN2 > group RDN3, while differences between group RDN2 and RDN3 in all time points are not statistical significant.There is no difference between group RDN1 and group RDN2 inthe first postoperative pain time and the PCA press time at 1h after operation. Difference between group RDN2 and group RDN3 in the PCA press time at 24 h after operation was not significant, and the fentanyl usage of RDN groups are significantly less than group R. Conclusions Combined use of dexmedetomidine and ultra-low dose naloxone induced by remifentanil can improving patients′postoperative hyperalgesia , effect increase with the dose of dexmedetomidine increas , and the increasement is more sensitive in acute pain.