酮咯酸氨丁三醇复合右美托咪定对瑞芬太尼致妇科腹腔镜患者术后痛觉过敏的影响
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摘要
目的探讨酮咯酸氨丁三醇复合右美托咪定对瑞芬太尼诱发术后痛觉过敏的影响。方法选取120例择期行妇科腹腔镜手术患者,随机分为对照组(C组),酮咯酸氨丁三醇组(K组)、右美托咪定组(D组)及酮咯酸氨丁三醇联合右美托咪定组(K+D组),每组30例。C组麻醉诱导期给予等容量生理盐水;K组静脉推注(静注)酮咯酸氨丁三醇30 mg;D组静注右美托咪定1.0μg/kg;K+D组静注右美托咪定0.5μg/kg,静注酮咯酸氨丁三醇15 mg。静注咪达唑仑0.05 mg/kg、舒芬太尼0.6μg/kg、异丙酚2.0 mg/kg及罗库溴铵0.7 mg/kg诱导麻醉。气管插管后行机械通气,维持呼气末二氧化碳分压(P_(ET)CO_2)35～40 mmHg。静注瑞芬太尼0.2～0.3μg·kg~(-1)·min~(-1)、异丙酚4～6 mg·kg~(-1)·h~(-1),间断静注罗库溴铵0.1～0.3 mg/kg,维持BIS值40～60。术后采用舒芬太尼行PCIA,维持VAS评分<4分。比较各组术后30 min,60 min,6 h,12 h及24 h时舒芬太尼用量;比较各组恶心呕吐、低血压、心动过缓、嗜睡及胃肠道出血发生率。结果与C组比较,K,D组及K+D组术后各时点舒芬太尼用量均显著降低(P<0.05);K,D组及K+D组术后各时点舒芬太尼用量比较,差别无统计学意义(P>0.05)。与C组比较,K,D组及K+D组恶心呕吐率显著降低(P<0.05),D组低血压、心动过缓率显著增高(P<0.05);与D组比较,K+D组低血压、心动过缓率显著降低(P<0.05);各组嗜睡率、胃肠道出血比较,差别无统计学意义(P>0.05)。结论酮咯酸氨丁三醇与右美托咪定复合使用时,其降低术后痛觉过敏的作用并不优于两者单独使用,但可减少右美托咪定单独使用时的并发症。
Objective To evaluate the effect of ketorolac tromethamine combined with dexmedetomidine on postoperative hyperalgesia induced by remifentanil. Methods 120 patients, scheduled for elective gynecological laparoscopic surgery under general anesthesia, were randomly divided into control group(C group), ketorolac tromethamine group(K group), dexmedetomidine group(D group), and ketorolac tromethamine combined with dexmedetomidine group(K+D group), 30 cases in each group. In C group, the equal volume of normal saline was given instead before anesthesia induction. In K group, ketorolac tromethamine 30 mg was injected before anesthesia induction. In D group, dexmedetomidine 1.0 μg/kg was infused before anesthesia induction. In K+D group, dexmedetomidine 0.5 μg/kg was infused before anesthesia induction, and ketorolac tromethamine 15 mg was injected before anesthesia induction. Anesthesia was induced by injection of midazolam 0.05 mg/kg, sufentanil 0.6 μg/kg, propofol 2.0 mg/kg, and rocuronium bromide 0.7 mg/kg. After tracheal intubation, the patients were mechanically ventilated, and P_(ET)CO_2 was maintained at 35～40 mmHg. Anesthesia was maintained by injection of remifentanil 0.2～0.3 μg·kg~(-1)·min~(-1 ) and propofol 4～6 mg·kg~(-1)·h~(-1), discontinuously injection rocuronium bromide 0.1～0.3 mg/kg, and BIS value was maintained at 40～60. After operation, PCIA with sufentanil was used, and VAS score was maintained <4 score. Thirty min, 60 min, 6 h, 12 h and 24 h post-operation, the sufentanil consumption were compared between the four groups. The incidence rate of nausea and vomiting, hypotension, bradycardia, drowsiness, and gastrointestinal bleeding were compared between the four groups. Results Compared with C group, the sufentanil consumption in K group, D group, and K+D group significantly decreased(P<0.05). The sufentanil consumption between K group, D group, and K+D group were not statistically different(P>0.05). Compared with C group, the nausea and vomiting rate in K group, D group, and K+D group were significantly decreased(P<0.05), while the hypotension and bradycardia rate in D group were significantly increased(P<0.05). Compared with D group, the hypotension and bradycardia rate in K+D group were significantly decreased(P<0.05). The drowsiness rate and gastrointestinal bleeding rate among four groups were not statistically differenct(P>0.05). Conclusion The combined effect of ketorolac tromethamine and dexmedetomidine in not better than that of the two alone, but it may reduce the complications of dexmedetomidine alone.
Objective To evaluate the effect of ketorolac tromethamine combined with dexmedetomidine on postoperative hyperalgesia induced by remifentanil. Methods 120 patients, scheduled for elective gynecological laparoscopic surgery under general anesthesia, were randomly divided into control group(C group), ketorolac tromethamine group(K group), dexmedetomidine group(D group), and ketorolac tromethamine combined with dexmedetomidine group(K+D group), 30 cases in each group. In C group, the equal volume of normal saline was given instead before anesthesia induction. In K group, ketorolac tromethamine 30 mg was injected before anesthesia induction. In D group, dexmedetomidine 1.0 μg/kg was infused before anesthesia induction. In K+D group, dexmedetomidine 0.5 μg/kg was infused before anesthesia induction, and ketorolac tromethamine 15 mg was injected before anesthesia induction. Anesthesia was induced by injection of midazolam 0.05 mg/kg, sufentanil 0.6 μg/kg, propofol 2.0 mg/kg, and rocuronium bromide 0.7 mg/kg. After tracheal intubation, the patients were mechanically ventilated, and P_(ET)CO_2 was maintained at 35～40 mmHg. Anesthesia was maintained by injection of remifentanil 0.2～0.3 μg·kg~(-1)·min~(-1 ) and propofol 4～6 mg·kg~(-1)·h~(-1), discontinuously injection rocuronium bromide 0.1～0.3 mg/kg, and BIS value was maintained at 40～60. After operation, PCIA with sufentanil was used, and VAS score was maintained <4 score. Thirty min, 60 min, 6 h, 12 h and 24 h post-operation, the sufentanil consumption were compared between the four groups. The incidence rate of nausea and vomiting, hypotension, bradycardia, drowsiness, and gastrointestinal bleeding were compared between the four groups. Results Compared with C group, the sufentanil consumption in K group, D group, and K+D group significantly decreased(P<0.05). The sufentanil consumption between K group, D group, and K+D group were not statistically different(P>0.05). Compared with C group, the nausea and vomiting rate in K group, D group, and K+D group were significantly decreased(P<0.05), while the hypotension and bradycardia rate in D group were significantly increased(P<0.05). Compared with D group, the hypotension and bradycardia rate in K+D group were significantly decreased(P<0.05). The drowsiness rate and gastrointestinal bleeding rate among four groups were not statistically differenct(P>0.05). Conclusion The combined effect of ketorolac tromethamine and dexmedetomidine in not better than that of the two alone, but it may reduce the complications of dexmedetomidine alone.
引文
[1] Leal P C,Salomao R,Brunialti M K,et al. Evaluation of the effect of ketamine on remifentanil-induced hyperalgesia: a double-blind, randomized study[J]. J Clinical Anesthesia, 2015,27(4):331-337.
[2] Deng L,Zhang L,Zhao H,et al. The role of p38MAPK activation in spinal dorsal horn in remifentanil-induced postoperative hyperalgesia in rats[J]. Neurological Research,2016,38(10):929-933.
[3] Yuan Y,Zhe S,Yi C,et al. Prevention of remifentanil induced postoperative hyperalgesia by dexmedetomidine via regulating the trafficking and function of spinal NMDA receptors as well as PKC and CaMKII level in vivo and in vitro[J]. Plos One, 2017,12(2):e0171348.
[4] 卢正义,徐鹏,吕机生. 酮咯酸氨丁三醇治疗瑞芬太尼痛觉过敏的效果观察[J]. 中国基层医药,2012,19(20):3144-3145.
[5] Yu Z,Wu W,Wu X,et al. Protective effects of dexmedetomidine combined with flurbiprofen axetil on remifentanil-induced hyperalgesia: A randomized controlled trial[J]. Experimental & Therapeutic Medicine,2016,12(4):2622-2628.
[6] Sun J,Lin H,He G,et al. Magnesium sulphate attenuate remifentanil-induced postoperative hyperalgesia via regulating tyrosine phosphorylation of the NR2B subunit of the NMDA receptor in the spinal cord[J]. BMC Anesthesiol,2017,17(1):30-35.
[7] 张麟临,赵亓,王新,等. 氟比洛芬酯复合地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果[J]. 中华麻醉学杂志,2016,36(4):392-395.
[8] 谢国柱,袁志国,卞丽玉,等. 酮咯酸氨丁三醇对舒芬太尼用于老年病人术后镇痛的节俭作用[J]. 中华麻醉学杂志,2012,32(5):573-575.
[9] 刘兆坤,朱晓红,贾有娟. 酮咯酸氨丁三醇对妇科手术患者术后吗啡静脉镇痛的影响[J]. 临床麻醉学杂志,2013,29(1):85-86.
[10] Cheol L,Kim Y D, Kim J N. Antihyperalgesic effects of dexmedetomidine on high-dose remifentanil-induced hyperalgesia[J]. Korean J Anesthesiology,2013,64(4):301-307.
[11] Kimura M,Saito S,Obata H. Dexmedetomidine decreases hyperalgesia in neuropathic pain by increasing acetylcholine in the spinal cord[J]. Neuroscience Letters,2012,529(1):70-74.
[12] Sun J,Wu B,Hu Y H,et al. Effects of intraoperative dexmedetomidine infusion on remifentanil-induced hyperalgesia[J]. J Clinical Anesthesiology,2013,29(4):356-358.
[13] 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.
[14] 田立东,张麟临,刘继强,等. 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[J]. 中华麻醉学杂志,2015,35(4):401-404.
[2] Deng L,Zhang L,Zhao H,et al. The role of p38MAPK activation in spinal dorsal horn in remifentanil-induced postoperative hyperalgesia in rats[J]. Neurological Research,2016,38(10):929-933.
[3] Yuan Y,Zhe S,Yi C,et al. Prevention of remifentanil induced postoperative hyperalgesia by dexmedetomidine via regulating the trafficking and function of spinal NMDA receptors as well as PKC and CaMKII level in vivo and in vitro[J]. Plos One, 2017,12(2):e0171348.
[4] 卢正义,徐鹏,吕机生. 酮咯酸氨丁三醇治疗瑞芬太尼痛觉过敏的效果观察[J]. 中国基层医药,2012,19(20):3144-3145.
[5] Yu Z,Wu W,Wu X,et al. Protective effects of dexmedetomidine combined with flurbiprofen axetil on remifentanil-induced hyperalgesia: A randomized controlled trial[J]. Experimental & Therapeutic Medicine,2016,12(4):2622-2628.
[6] Sun J,Lin H,He G,et al. Magnesium sulphate attenuate remifentanil-induced postoperative hyperalgesia via regulating tyrosine phosphorylation of the NR2B subunit of the NMDA receptor in the spinal cord[J]. BMC Anesthesiol,2017,17(1):30-35.
[7] 张麟临,赵亓,王新,等. 氟比洛芬酯复合地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果[J]. 中华麻醉学杂志,2016,36(4):392-395.
[8] 谢国柱,袁志国,卞丽玉,等. 酮咯酸氨丁三醇对舒芬太尼用于老年病人术后镇痛的节俭作用[J]. 中华麻醉学杂志,2012,32(5):573-575.
[9] 刘兆坤,朱晓红,贾有娟. 酮咯酸氨丁三醇对妇科手术患者术后吗啡静脉镇痛的影响[J]. 临床麻醉学杂志,2013,29(1):85-86.
[10] Cheol L,Kim Y D, Kim J N. Antihyperalgesic effects of dexmedetomidine on high-dose remifentanil-induced hyperalgesia[J]. Korean J Anesthesiology,2013,64(4):301-307.
[11] Kimura M,Saito S,Obata H. Dexmedetomidine decreases hyperalgesia in neuropathic pain by increasing acetylcholine in the spinal cord[J]. Neuroscience Letters,2012,529(1):70-74.
[12] Sun J,Wu B,Hu Y H,et al. Effects of intraoperative dexmedetomidine infusion on remifentanil-induced hyperalgesia[J]. J Clinical Anesthesiology,2013,29(4):356-358.
[13] 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.
[14] 田立东,张麟临,刘继强,等. 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[J]. 中华麻醉学杂志,2015,35(4):401-404.