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目的探讨围术期使用N-甲基-D-天门冬氨酸(NMDA)受体拮抗剂右美沙芬(Dextromethor-phan,DM)缓解乳腺根治术后疼痛的效应及对术后阿片类镇痛药物用量的影响。方法40例女性乳腺癌择期手术患者,随机分为四组A组于切皮前30min及术毕肌注DM1mg/kg;B组仅在切皮前30min肌注DM1mg/kg;C组于术毕肌注DM1mg/kg;D组为生量盐水对照组,四组病人术后均接受芬太尼肌内缓释自控镇痛措施。记录术毕至PCA泵开放的时间及术后不同时间点的累计消耗量、疼痛记分及镇痛相关的副作用(如恶心、呕吐、嗑睡、头晕、呼吸抑制等)。结果从手术结束至PCA泵开放的时间A组明显长于B、C组(P<0.05)及D组(P<0.01),B、C两组间无显著差异(P>0.05),但也均较D组长(P<0.05)。术后各时点芬太尼累计使用量A,B和C三组均较D组明显减少(P<0.01);4h后A组用量小于B、C组(P<0.05);B组与C组比较虽有减小趋势,但无统计学差异(P>0.05)。VAS评分A组在术后2,4,24和48h较D组明显减小(P<0.01),8h时点未见显著差异(P>0.05),B、C两组在术后48h时的VAS评分明显小于D组,其它各时点未见明显差异(P>0.05)。各组均未见典型的芬太尼相关副作用。结论围术期使用DM可提高术后镇痛的效果,延迟患者对阿片类药物的需求并减少阿片类药物的用量,并且术前及术后各肌注DM1mg/kg的用?
Objective To investigate the effect of Dextromethor-phan (DM) on pain relief after radical mastectomy and its effect on postoperative opioid analgesia The effect of drug usage. Methods Forty female patients undergoing elective surgery for breast cancer were randomly divided into four groups: group A, 30 minutes before skin incision and 1 mg / kg intramuscular injection of DM; Group B received intramuscular injection of 1 mg / kg 30 min before skin incision; Intramuscular injection of DM1mg / kg; D group for the saline control group, four groups of patients were received postoperative intramuscular slow-release fentanyl controlled analgesic measures. The cumulative time from the recording of the PCA pump to the opening of the PCA pump at different time points after surgery, the pain score, and pain-related side effects such as nausea, vomiting, sleepiness, dizziness, respiratory depression, etc. were recorded. Results The time from the end of operation to the opening of PCA pump in group A was significantly longer than that in group B and C (P <0.05) and group D (P <0.01), while there was no significant difference between group B and C (P> 0.05) Compared with group D (P <0.05). The total amount of fentanyl at each time point after operation was significantly lower in group A, B and C than that in group D (P <0.01); after 4 hours, the dosage of group A was less than that in group B and C (P <0.05) There was no significant difference between the two groups (P> 0.05). VAS score in group A at 2, 4, 24 and 48h after operation was significantly lower than that at D group (P <0.01), but no significant difference at 8h (P> 0.05) VAS score was significantly less than the D group, no significant difference at other time points (P> 0.05). No typical fentanyl-related side effects were seen in either group. Conclusion Perioperative use of DM can improve postoperative analgesia, delaying the demand for opiates and reducing the consumption of opioids, and preoperative and postoperative intramuscular injection of DM1mg / kg?