右美托咪定与高乌甲素联用对经瑞芬太尼麻醉后患者痛觉过敏的影响
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摘要
目的探讨右美托咪定与高乌甲素联用对经瑞芬太尼麻醉后患者的痛觉过敏的影响。方法选取2015年6月至2017年4月期间于上海第一人民医院宝山分院治疗的190例经瑞芬太尼麻醉患者作为研究对象,采用随机数表法将患者均分为对照组和观察组各95例,对照组采用泵注右美托咪定治疗,观察组在对照组的基础上加用高乌甲素泵注治疗。观察并比较两组患者的心率、平均动脉压以及镇静评分,比较两组患者的VAS评分和不良反应发生率。结果观察组患者在手术拔管后1 h时心率为(75.3±2.8)次/min,平均动脉压为(92.7±3.6) mmHg,明显低于对照组的(90.6±3.2)次/min、(105.4±5.1) mmHg,差异均有统计学意义(P<0.05);观察组患者的镇静评分为(3.56±0.12)分,明显高于对照组的(2.05±0.06)分;VAS疼痛评分为(1.66±0.11)分,明显低于对照组的(2.91±0.13)分,差异均有统计学意义(P<0.05);观察组患者术后不良反应发生率为15.8%,明显低于对照组的29.5%,差异有统计学意义(P<0.05)。结论右美托咪定联合高乌甲素的应用能够改善经瑞芬太尼麻醉后的患者的痛觉过敏现象,促进患者的心率、动脉压恢复到正常水平,并有效改善患者的疼痛感。右美托咪定联合高乌甲素的应用能够帮助患者保持镇静,并降低不良反应发生率,值得临床推广。
Objective To explore the effects of dexmedetomidine combined with lappaconitine on hyperalgesia in patients after anesthesia with remifentanil. Methods A total of 190 patients with remifentanil anesthesia treated in the Baoshan Branch of Shanghai General Hospital from June 2015 to April 2017 were selected as subjects. The patients were divided into control group and observation group by random number table method, with 95 cases in each group. Patients treated with pumped dexmedetomidine were enrolled in the control group, and patients additionally treated with pumped lappaconitine on the basis of the control group were selected in the observation group. The heart rate, mean arterial pressure and sedation scores of the two groups were observed and compared. And the VAS scores and adverse reactions were compared between the two groups. Results The heart rate of(75.3±2.8) times/min and mean arterial pressure of(92.7±3.6) mm Hg of the observation group at 1 h after surgical extubation were significantly lower than those of the control group, and both differences were statistically significant(P<0.05). The sedation score of the observation group(3.56 ±0.12) was higher than that(2.05±0.06) of the control group, and the VAS pain score of the observation group(1.66±0.11)was lower than that(2.91±0.13) of the control group; both differences were statistically significant(P<0.05). The incidence of postoperative adverse reactions in the observation group was 15.8%, which was significantly lower than 29.5%in the control group(P<0.05). Conclusion The combination of dexmedetomidine and lappaconitine can improve the hyperalgesia of patients after remifentanil anesthesia, promote the recovery of patient's heart rate and arterial pressure to normal levels, and effectively improve the patient's pain. The combination of dexmedetomidine and lappaconitine can help patients maintain sedation and reduce the incidence of adverse reactions, which is worthy of clinical promotion.
Objective To explore the effects of dexmedetomidine combined with lappaconitine on hyperalgesia in patients after anesthesia with remifentanil. Methods A total of 190 patients with remifentanil anesthesia treated in the Baoshan Branch of Shanghai General Hospital from June 2015 to April 2017 were selected as subjects. The patients were divided into control group and observation group by random number table method, with 95 cases in each group. Patients treated with pumped dexmedetomidine were enrolled in the control group, and patients additionally treated with pumped lappaconitine on the basis of the control group were selected in the observation group. The heart rate, mean arterial pressure and sedation scores of the two groups were observed and compared. And the VAS scores and adverse reactions were compared between the two groups. Results The heart rate of(75.3±2.8) times/min and mean arterial pressure of(92.7±3.6) mm Hg of the observation group at 1 h after surgical extubation were significantly lower than those of the control group, and both differences were statistically significant(P<0.05). The sedation score of the observation group(3.56 ±0.12) was higher than that(2.05±0.06) of the control group, and the VAS pain score of the observation group(1.66±0.11)was lower than that(2.91±0.13) of the control group; both differences were statistically significant(P<0.05). The incidence of postoperative adverse reactions in the observation group was 15.8%, which was significantly lower than 29.5%in the control group(P<0.05). Conclusion The combination of dexmedetomidine and lappaconitine can improve the hyperalgesia of patients after remifentanil anesthesia, promote the recovery of patient's heart rate and arterial pressure to normal levels, and effectively improve the patient's pain. The combination of dexmedetomidine and lappaconitine can help patients maintain sedation and reduce the incidence of adverse reactions, which is worthy of clinical promotion.
引文
[1]王东昕,杨静远,姜新,等.右美托咪定对老年患者应用瑞芬太尼后痛觉过敏的影响[J].中国老年学杂志, 2013, 33(23):5873-5875.
[2]刘国凯,黄宇光,罗爱伦.小剂量氯胺酮用于术后镇痛的研究及其临床价值[J].中华麻醉学杂志, 2013, 23(3):23-25.
[3]张瑶,孙茜,许倩,等.右美托咪定预防大鼠创伤后应激障碍的效果及其对海马ERK活性及ARC表达的影响[J].中华麻醉学杂志,2013, 33(2):242-244.
[4]肖纯,卢波,姚娟,等.右美托咪定对瑞芬太尼所致术后痛觉过敏与急性疼痛的影响[J].中华医学杂志, 2013, 93(1):44-47.
[5] BETHANY R, TELLOR HEATHER M, ARNOLD SCOTT T, et al.Occurrence and predictors of dexmedetomidine infusion intoleranceand failure[J]. Hospital Practice, 2012, 40(1):186-192.
[6] BHADLA S, PRAJAPATI D, LOUTS T, et al. Comparison betweendexmedetomidine and midazolam premedication in pediatric patientsundergoing ophthalmic day-care surgeries[J]. Anesthesia:Essays&Researches, 2013, 7(2):248.
[7]李家铁,冯继英,陈莺.大剂量瑞芬太尼增加上腹部术后慢性疼痛的发生[J].现代预防医学, 2011, 38(20):4300-4303.
[8]王瑜,蒋蓉,邓佳,等.右美托咪定联合帕瑞昔布钠预防瑞芬太尼麻醉后痛觉过敏[J].临床麻醉学杂志, 2014, 15(12):1152-1155.
[9] KANG WS, KIM SY, SON JC, et al. The effect of dexmedetomidineon the adjuvant propofol requirement and intraoperative hemodynam-ics during remifentanil-based anesthesia[J]. Korean Journal of Anes-thesiology, 2012, 62(2):113-118.
[10]张卫,周立君,阚全程,等.不同剂量右美托咪定与小剂量氯胺酮预防瑞芬太尼复合麻醉后痛觉过敏的效果比较[J].临床麻醉学杂志,2013, 29(5):435-438.
[11] DEWHIRST E, AYMEN A, JOSEPH N, et al. Dexmed etomidine aspart of balanced anesthesia care in children with malignant hyperther-mia risk and egg allergy[J]. The Journal of Pediatric Pharmacologyand Therapeutics, 2011, 16(2):113-117.
[12]李海中.高乌甲素联合右美托咪定对瑞芬太尼麻醉后痛觉过敏的影响[J].中国实用医刊, 2016, 43(2):125-126.
[13]章妙青,陈新忠.不同剂量右美托咪定预给药对瑞芬太尼致术后疼痛与痛觉过敏的影响[J].中国现代医生, 2014, 52(17):4-11.
[14]彭勉,王焱林,王成夭,等.右美托咪定预先给药对脂多糖诱导乳鼠原代小胶质细胞炎性介质释放的影响[J].中华麻醉学杂志, 2013,33(3):296-298.
[15]柴薪,张丽娜,汲元美,等.不同剂量右美托咪定对丙泊酚复合瑞芬太尼用于整形外科手术患者麻醉效果的影响[J].中华麻醉学杂志,2013, 33(3):306-310.
[2]刘国凯,黄宇光,罗爱伦.小剂量氯胺酮用于术后镇痛的研究及其临床价值[J].中华麻醉学杂志, 2013, 23(3):23-25.
[3]张瑶,孙茜,许倩,等.右美托咪定预防大鼠创伤后应激障碍的效果及其对海马ERK活性及ARC表达的影响[J].中华麻醉学杂志,2013, 33(2):242-244.
[4]肖纯,卢波,姚娟,等.右美托咪定对瑞芬太尼所致术后痛觉过敏与急性疼痛的影响[J].中华医学杂志, 2013, 93(1):44-47.
[5] BETHANY R, TELLOR HEATHER M, ARNOLD SCOTT T, et al.Occurrence and predictors of dexmedetomidine infusion intoleranceand failure[J]. Hospital Practice, 2012, 40(1):186-192.
[6] BHADLA S, PRAJAPATI D, LOUTS T, et al. Comparison betweendexmedetomidine and midazolam premedication in pediatric patientsundergoing ophthalmic day-care surgeries[J]. Anesthesia:Essays&Researches, 2013, 7(2):248.
[7]李家铁,冯继英,陈莺.大剂量瑞芬太尼增加上腹部术后慢性疼痛的发生[J].现代预防医学, 2011, 38(20):4300-4303.
[8]王瑜,蒋蓉,邓佳,等.右美托咪定联合帕瑞昔布钠预防瑞芬太尼麻醉后痛觉过敏[J].临床麻醉学杂志, 2014, 15(12):1152-1155.
[9] KANG WS, KIM SY, SON JC, et al. The effect of dexmedetomidineon the adjuvant propofol requirement and intraoperative hemodynam-ics during remifentanil-based anesthesia[J]. Korean Journal of Anes-thesiology, 2012, 62(2):113-118.
[10]张卫,周立君,阚全程,等.不同剂量右美托咪定与小剂量氯胺酮预防瑞芬太尼复合麻醉后痛觉过敏的效果比较[J].临床麻醉学杂志,2013, 29(5):435-438.
[11] DEWHIRST E, AYMEN A, JOSEPH N, et al. Dexmed etomidine aspart of balanced anesthesia care in children with malignant hyperther-mia risk and egg allergy[J]. The Journal of Pediatric Pharmacologyand Therapeutics, 2011, 16(2):113-117.
[12]李海中.高乌甲素联合右美托咪定对瑞芬太尼麻醉后痛觉过敏的影响[J].中国实用医刊, 2016, 43(2):125-126.
[13]章妙青,陈新忠.不同剂量右美托咪定预给药对瑞芬太尼致术后疼痛与痛觉过敏的影响[J].中国现代医生, 2014, 52(17):4-11.
[14]彭勉,王焱林,王成夭,等.右美托咪定预先给药对脂多糖诱导乳鼠原代小胶质细胞炎性介质释放的影响[J].中华麻醉学杂志, 2013,33(3):296-298.
[15]柴薪,张丽娜,汲元美,等.不同剂量右美托咪定对丙泊酚复合瑞芬太尼用于整形外科手术患者麻醉效果的影响[J].中华麻醉学杂志,2013, 33(3):306-310.