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| 术中持续输注右美托咪定对降低经腹子宫切除术后慢性疼痛的影响 |
| Dexmedetomidine preventive chronic post-hysterectomy pain |
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| DOI：10.12089/jca.2017.12.1155 |
| 中文关键词: 右美托咪定 预先镇痛 术后慢性疼痛 子宫切除术 |
| 英文关键词: Dexmedetomidine Preventive analgesia Chronic post-surgical pain Hysterectomy |
| 基金项目:无锡市科技局医疗与公众健康技术研发项目（CSE31N1522） |
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| 中文摘要: |
目的 探讨右美托咪定预先镇痛对全麻经腹子宫切除术患者术后慢性疼痛(CPSP)的影响。
方法 择期行全麻经腹子宫切除术患者71例,年龄18～65岁,ASA Ⅰ或Ⅱ级,随机分为右美托咪定组(D组,n=37)和对照组(C组,n=34)。两组患者均行丙泊酚-瑞芬太尼全凭静脉麻醉。从麻醉诱导开始至手术结束气管拔管,D组持续静脉输注右美托咪定0.5 μg·kg-1·h-1,而C组则给予生理盐水0.125 ml·kg-1·h-1。术后患者均接受芬太尼静脉自控镇痛。记录术中生命体征、围术期镇痛镇静药用量和不良反应。电话随访评估术后3、6、12个月的CPSP发生情况。
结果 两组患者围术期生命体征均平稳,未见明显不良反应,D组术后补救镇痛使用曲马多总量明显少于C组[(58.8±15.4) mg vs (78.9±24.5) mg,P<0.05]。术后 3、 6、12个月,D组CPSP发生率分别为10.8%、5.4%、2.7%,明显低于C组的35.3%、26.5%、17.6% (P<0.05)。D组术后3、6个月神经病理性疼痛（NP）发病率分别为2.7%、0%,明显低于C组的17.6%、14.7% (P<0.05)。
结论 右美托咪定预先镇痛可以降低经腹子宫切除术后CPSP的发生率。 |
| 英文摘要: |
Objective To investigate the effects of dexmedetomidine preventive on chronic postsurgical pain (CPSP) in patients undergoing hysterectomy.
Methods Eighty patients scheduled for elective abdominal hysterectomy, aged 18-65 years, ASA physical status Ⅰ or Ⅱ were recruited, and randomly divided into dexmedetomidine group (group D) and the control group (group C). All patients received total intravenous anesthesia with propofol and remifentanil. The patients in group D were administered intravenously dexmedetomidine 0.5 μg·kg-1·h-1 from anesthesia induction to extubation at the end of surgery, while the patients in group C were administered normal saline 0.125 ml·kg-1·h-1. All patients received patient-controlled analgesia with fentanyl postoperatively. Intra-operative vital signs, the dose of analgesic and sedatives, and adverse reactions were recorded. CPSP and neuropathic pain (NP) were evaluated through the telephone follow-up in 3, 6 and 12 months postoperatively.
Results The peri-operative vital signs of both groups were stable, and no obvious adverse reaction were observed. The dosage of tramadol used for resue analgesia in group D was lower than that in group C [(58.8±15.4) mg vs (78.9±24.5) mg,P<0.05]. Seventy-one of eighty patients completed all follow-up (37 in group D, 34 in group C). The incidence of CPSP in postoperative 3, 6 and 12 months were 10.8%, 5.4%, 2.7% in group D,significantly lower than 35.3%,26.5%,17.6% in group C, respectively (P<0.05). The incidence of NP in postoperative 3 and 6 months were 2.7%, 0%, significantly lower than 17.6%, 14.7% in group C, respectively (P<0.05).
Conclusion Dexmedetomidine preventive analgesia alleviate chronic post-hysterectomy pain. |
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