摘要
目的 评价不同小剂量纳美芬预防瑞芬太尼诱发患者术后痛觉过敏的效果.方法择期全麻妇科腹腔镜手术患者100例,年龄20～64岁,ASA分级Ⅰ或Ⅱ级,体重指数18～25 kg∕m^2,采用随机数字表法分为4组（n=25）：对照组（C组）和不同剂量纳美芬组（N1组、N2组和N3组）.N1组、N2组和N3组诱导前5 min分别静脉注射纳美芬0.2、0.3、0.5 μg∕kg（生理盐水稀释至5 ml）,C组静脉注射生理盐水5 ml.麻醉诱导：静脉注射咪达唑仑0.05 mg∕kg、舒芬太尼0.3 μg∕kg、依托咪酯0.3 mg∕kg和罗库溴铵0.6 mg∕kg,气管插管术后行机械通气.麻醉维持：静脉输注瑞芬太尼0.3 μg·kg^-1·min^-1,复合吸入4%～6% 地氟醚,维持BIS值45～60,间断静脉注射罗库溴铵维持肌松.入PACU后行PCA,镇痛方案：舒芬太尼1 μg∕ml,容量100 ml,背景输注速率2 ml∕h,PCA量0.5 ml,锁定时间15 min.维持数字疼痛强度量表评分〈4分.记录瑞芬太尼输注时间.于术后0～1、1～3、3～6、6～12和12～24 h时段记录舒芬太尼用量,记录术后24 h内恶心、呕吐、心动过速、高血压和寒战的发生情况.结果 与C组比较,N1组术后0～1和1～3 h舒芬太尼用量减少,N2组术后0～1、1～3、3～6和6～12 h舒芬太尼用量减少,N1组、N2组和N3组术后恶心发生率降低（P〈0.05）;与N1组比较,N2组术后3～6 h舒芬太尼用量减少（P〈0.05）.结论 小剂量纳美芬预防瑞芬太尼诱发术后痛觉过敏的适宜剂量为0.3 μg∕kg.
Objective To evaluate the efficacy of different low-doses of nalmefene in preventing remifentanil-induced postoperative hyperalgesia. Methods One hundred American Society of Anesthesiolo-gist physical status Ⅰor Ⅱpatients, aged 20-64 yr, wih body mass index of 18-25 kg∕m^2, scheduled for elective gynecological laparoscopic surgery under general anesthesia, were divided into 4 groups（n=25 each）using a random number table： control group（group C）and different doses of nalmefene groups （N1, N2 and N3 groups）. In N1, N2 and N3 groups, nalmefene 02, 03 and 05 μg∕kg（diluted to 5 ml in normal saline）were intravenously injected, respectively, at 5 min before anesthesia induction, while the equal volume of normal saline was given in group C. Anesthesia was induced with midazolam 0.05 mg∕kg, sufentanil 03 μg∕kg, etomidate 03 mg∕kg and rocuronium 06 mg∕kg. The patients were me-chanically ventilated after tracheal intubation. Anesthesia was maintained by IV infusion of remifentanil 03 μg·kg^-1·min^-1 and inhalation of 4%-6% desflurane, bispectral index value was maintained at 45-60, and muscle relaxation was maintained with intermittent IV boluses of rocuronium. After admission to postan-esthesia care unit, patient-controlled analgesia（PCA）was performed, and PCA solution contained sufen-tanil 1 μg∕ml in 100 ml of normal saline. PCA pump was programmed to deliver a 05 ml bolus dose with a lockout interval of 15 min and background infusion at 2 ml∕h. Numeric rating scale score was maintained 〈4. The time for remifentanil infusion was recorded. The consumption of sufentanil was recorded in 0-1, 1-3, 3-6, 6-12 and 12-24 h periods after surgery, and the occurrence of nausea, vomiting, tachycardia, hypertension and shivering was also recorded within 24 h after surgery. Results Compared with group C, the postoperative consumption of sufentanil was significantly reduced in 0-1 h and 1-3 h periods after sur-gery in group N1 and in 0-1, 1-3, 3-6 and 6-12 h periods after surgery in group
出处
《中华麻醉学杂志》
CSCD
北大核心
2017年第10期1159-1162,共4页
Chinese Journal of Anesthesiology
基金
国家自然科学基金（81571077,81371245）
天津市卫生局基金（2012KZ102）
