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

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-·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.%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 0.5μg·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.Intraoperative 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.