摘要
目的 探讨帕瑞昔布钠不同给药时机对瑞芬太尼复合麻醉患者术后急性阿片类药物耐受的影响.方法 择期拟行胆囊切除术患者54例,ASA Ⅰ或Ⅱ级,年龄30～64岁,随机分为3组（n=18）：均靶控输注异丙酚（血浆靶浓度3μg/ml）和瑞芬太尼（血浆靶浓度4 ng/m1）行麻醉诱导和维持,Ⅰ 组和Ⅱ组分别于麻醉前30 min、术毕前30 min静脉注射帕瑞昔布钠40 mg,C组为对照组.术后在麻醉复苏室30 min内每隔5 min询问患者的疼痛情况,疼痛评分〉0分时,静脉注射吗啡2 rag,30 min后连接病人自控静脉镇痛泵（按压1次吗啡剂量1-1lg,锁定时间5 min）返回病房,记录术后30 min内、30 min～24 h及24～48 h的吗啡用量,观察不良反应的发生情况.结果 与C组比较,Ⅰ组术后48 h内各时段、Ⅱ组术后30 min～24 h及24～48 h的吗啡用量降低（P〈0.05）,Ⅱ组术后30 min内差异无统计学意义（P〉0.05）;与Ⅰ组比较,Ⅱ组术后30 min内吗啡用量升高（P〈0.05）.各组均未见不良反应发生.结论 麻醉前30 rain静脉注射帕瑞昔布钠40 mg可有效减轻瑞芬太尼复合麻醉患者术后早期的急性阿片类药物耐受.
Objective To investigate the effects of different time administration of parecoxib sodium on acute opioid tolerance after remifentanil-based anesthesia in patients. Methods Fifty-four ASA Ⅰ or Ⅱ patients aged 30-64 yr undergoing transabdominal cholecystcctomy were randomly divided into 3 groups （ n = 18 each） ： group Ⅰ- received parecoxib 40 mg at 30 rain before anesthesia; group Ⅱ received parecoxib 40 mg at 30 rain before termination of anesthesia; group C control. Anesthesia was induced and maintained with prepefol and remifentanil administered via TCI. The target plasma concentration of propefol was set at 3 μg/ml and that of remifentanil at 4 ng/ml. Traeheal intubation was facilitated with rocuronium 0.6 mg/kg. Muscle relaxation was maintained with intermittent iv boluses of vecuronium during operation. Pain was assessed using behavioral pain score （0 = quiet and no pain, 1 = complaining, 2 = severe pain and/or agitation）. When the pain score 〉 0, the patients received iv injection of morphine and then PCIA with morphine （bolus dose 1 rag, lockout interval 5 min, no background infusion） 30 min later. Morphine consumption and side effects were recorded within 30 min, and during 30 rain-24 h and 24-48 h after operation. Results Compared with group C, the morphine consumption was significantly decreased during all the time periods within 48 h after operation in group Ⅰ and during 30 min-24 h and 24-48 h after operation in group Ⅱ（ P 〈 0.05 ）. The morphine consumption was significantly higher within 30 min after operation in group Ⅱ than in group Ⅰ （ P 〈 0.05 ）. No obvious side effects occurred in the 3 groups. Condusion Parecoxib sodium 40 mg given before anesthesia can reduce acute opioid tolerance after remifentanil-based anesthesia in patients.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2010年第4期424-426,共3页
Chinese Journal of Anesthesiology
