摘要
目的观察术中应用右美托咪定对乳腺癌术后慢性疼痛发生率的影响。方法选择美国麻醉医师协会(ASA)Ⅰ或Ⅱ级全麻下乳腺癌改良根治手术患者160例,随机分为全麻+右美托咪定组(D组)和单纯全麻组(N组)。记录患两组患者术前1 d、麻醉苏醒后即刻、术后24 h、48 h机械痛阈值;采用视觉模拟评分法(VAS)评估患者术前1 d、麻醉苏醒后即刻、术后24 h、术后48 h、术后3个月疼痛评分,并统计两组慢性疼痛发生率以及术后芬太尼使用量。结果 N组患者在苏醒即刻、术后24 h及术后48 h痛阈较术前明显降低(q分别=83.31、14.61、9.45,P均<0.05),D组苏醒即刻痛阈、术后24 h痛阈值和术后48 h痛阈值与N组相同时间点比较,疼痛阈值均明显增高(t分别=28.68、4.15、2.76,P均<0.05)。D组在苏醒即刻及术后24 h VAS评分明显低于N组(t分别=15.78、3.42,P均<0.05),D组术后经静脉患者自控镇痛(PCIA)的按压次数及芬太尼使用量比N组明显减少,术后3个月的慢性疼痛发生率比N组明显降低,差异均有统计学意义(t分别=9.52、3.42,χ2=7.33,P均<0.05)。结论术中应用右美托咪定能有效提高术中应用瑞芬太尼乳腺癌患者术后痛阈及降低VAS评分,减少术后阿片类药物的应用,降低慢性疼痛的发生率。
Objective To observe the effect of dexmedetomidine applied in intraoperation on the incidence of postoperative chronic pain for patient with mammary cancer. Methods One hundred and sixty patients who underwent radical mastectomy under general anesthesia were randomized into the group N（general anesthesia）and group D（general anesthesia combined with dexmedetomidine）. Mechanical pain thresholds and visual analogue scale（VAS）were evaluated at the following points：one day before operation,immediately after anesthesia recovery,24 hours and 48 hours after surgery. The incidence of chronic pain in postoperative and usage of fentanyl were recorded. Results The mechanical pain thresholds of group N at immediately after anesthesia recovery,24 hours and 48 hours after surgery were significantly decreased when compared to the point of one day before operation（q=83.31,14.61,9.45,P〈0.05）. The mechanical pain thresholds of group D at immediately after anesthesia recovery,24 hours and 48 hours after surgery were significantly higher than those of group N（t=28.68,4.15,2.76,P〈0.05）.The VAS scores of group D at immediately after anesthesia recovery,24 hours after surgery were significantly lower than those of the group N（t=15.78,3.42,P〈0.05）.The pressing number after PCIA of group D was significantly less than that of group N as well as the fentanyl usage and the incidence of chronic pain at 3 months after surgery（t=9.52,3.42,χ2=7.33,P〈0.05）. Conclusion Intraoperative administration of dexmedetomidine can effectively increasethe pain thresholds and decrease the VAS score in radical mastectomy patients who undergo general anesthesia with remifentanil. It can also reduce fentanyl application and the incidence of chronic pain.
作者
孔敏
周煦燕
姜黎珊
俞丹红
李瑛
沈徐
姚明
KONG Min;ZHOU Xuyan;JIANG Lishan(Department of Anesthesiology,The First Hospitalof Jiaxing,Jiaxing 314000,China)
出处
《全科医学临床与教育》
2018年第3期267-269,273,共4页
Clinical Education of General Practice
基金
浙江省嘉兴市科技工作专项计划(2014AY21024)
关键词
慢性疼痛
乳腺癌
右美托咪定
chronic pain
mammary cancer
dexmedetomidine
