摘要
目的探讨帕瑞昔布钠对瑞芬太尼复合麻醉诱发患者术后痛觉过敏的影响。方法择期腹腔镜手术患者100例，性别不限，AsA分级工或Ⅱ级，年龄21～64岁，体重50，80奴，采用随机数字表法，将其随机分为5组（n=20）：帕瑞昔布钠组（P组）、小剂量瑞芬太尼组（S组）、大剂量瑞芬太尼组（L组）、小剂量瑞芬太尼＋帕瑞昔布钠组（SP组）和大剂量瑞芬太尼＋帕瑞昔布钠组（LP组）。P组、LP组和SP组麻醉前30min时静脉注射帕瑞昔布钠40mg。依次静脉注射咪达唑仑、依托咪酯、顺阿曲库铵和瑞芬太尼（P组芬太尼）麻醉诱导。麻醉维持：S组和SP组静脉输注瑞芬太尼0．05μg·kg^-1·min^-1，L组和LP组静脉输注瑞芬太尼0．3μg·kg^-1·min^-1，各组均复合吸入七氟醚，静脉输注顺阿曲库铵。于术后30min时采用数字评分法（NRS）评估静态和动态切VI疼痛程度，术后镇痛的辅助措施采用静脉注射曲马多1．5mg／kg，维持NRS评分≤5分。记录术后24h内曲马多使用情况和不良反应发生情况。结果与P组比较，S组和L组术后30min时静态和动态NRS评分升高，L组寒颤发生率和曲马多使用率升高（P〈0．05），SP组和LP组术后30min时静态和动态NRS评分、不良反应发生率和曲马多使用率差异无统计学意义（P〉0．05）；与S组比较，L组术后30min时静态和动态NRS评分、寒颤发生率和曲马多使用率升高，SP组术后30min时静态和动态NRS评分降低（P〈0．05），不良反应发生率和曲马多使用率差异无统计学意义（P〉0．05）；与L组比较，LP组术后30min时静态和动态NRS评分、寒颤发生率和曲马多使用率降低（P〈0．05）。结论麻醉前30min静脉注射帕瑞昔布钠40mg可抑制瑞芬太尼复合麻醉诱发患者术后痛觉过敏。
Objective To investigate the effect of parecoxib on postoperative hyperalgesia induced by remifentanil-based anesthesia.Methods One hundred ASA I or II patients, aged 21-64 yr, weighing 50-80 kg, undergoing elective laparoscopic operation, were randomly divided into 5 groups （ n = 20 each） ： parecoxib group （group P）, small dose remifentanil group （group S）, large dose remifentanil group （group L）, small dose remifentanil ＋ parecoxib group （group SP） and large dose remifentanil ＋ parecoxib group （group LP）. Parecoxib 40 mg was injected intravenously at30 min before anesthesia in groups P, SP and LP. Anesthesia was induced with midazolam0.05 mg/kg, etomidate 0.2 mg/kg, cisatracurium 0.15 mg/kg and remifentanil 1 μg/kg （fentanyl 4 μg/kg in group P）. The patients was tracheal intubated and mechanically ventilated. PETCO2 was maintained at 35- 45 mmHg. Anesthesia was maintained with infusion of remifentanil at 0.05 t.tg＂ kg- 1. min- i （ in groups S and SP） or at 0.3 μg·kg^-1·min^-1 （ in groups L and LP） combined with inhalation of sevoflurane and infusion of cisatracurium at 0.12 μg·kg^-1·h^-1 . At 30 rain after operation, numeric rating scale （NRS） was used to assess the degree of pain at rest and during activity. Tramadol 1.5 mg/kg was injected intravenously after operation if needed. NRS scores were maintained ≤ 5. The use of tramadol and adverse effects during 24 h after operation were recorded. Results Compared with group P, NRS scores at rest and during activity were significantly increased at 30 min af- ter operation in groups S and L, the incidence of shivering and the number of patients who needed tramadol were significantly increased in group L, and no change was found in NRS scores at rest and during activity at 30 min after operation, the incidence of adverse effects and the number of patients who needed tramadol in groups SP and LP. Compared with group S, NRS scores at rest and during activity at 30 min after operation, the incidence of shivering
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第4期426-429,共4页
Chinese Journal of Anesthesiology
关键词
环氧化酶2抑制剂
哌啶类
痛觉过敏
疼痛
手术后
Cyclooxygenase 2 inhihitors
Piperidines
Hyperalgesia
Pain, postoperative
