氟比洛芬酯或小剂量氯胺酮有效预防雷米芬太尼麻醉术后痛觉过敏  

Prevention of remifentanil-induced postoperative hyperalgesia by flurbiprofen axetil or small-dose ketamine

作　　者：刘月江[1] 李秋兰[1] 祖翠华[1] 景亮[1] 

机构地区：[1]东南大学附属中大医院麻醉科,南京市210009

出　　处：《临床麻醉学杂志》2008年第10期856-858,共3页Journal of Clinical Anesthesiology

摘　　要：目的评价氟比洛芬酯或小剂量氯胺酮对于雷米芬太尼麻醉术后痛觉过敏的预防作用。方法60例ASAⅠ或Ⅱ级全身麻醉患者,年龄18～70岁,随机均分为三组:Ⅰ组应用雷米芬太尼的同时静脉注射氯胺酮0.5 mg/kg,继而5μg·kg-1·min-1静脉维持至手术结束;Ⅱ组术前氟比洛芬酯100 mg静脉注射;Ⅲ组不用氯胺酮或氟比洛芬酯作为对照。三组均用丙泊酚、雷米芬太尼维持麻醉。术后用曲马多持续静脉自控镇痛(PCIA)。结果Ⅲ组术后1、2、4、8 h视觉模拟评分(VAS)显著高于Ⅰ、Ⅱ组(P<0.05或P<0.01);术后24 h VAS三组间差异无统计学意义。术后24 h患者PCIA自控按压次数及加用芬太尼镇痛的病例数Ⅲ组显著多于Ⅰ、Ⅱ组(P<0.01)。结论超前应用氟比洛芬酯或术中持续应用小剂量氯胺酮均可有效预防雷米芬太尼麻醉术后痛觉过敏的发生,不影响患者苏醒,亦不增加不良反应的发生。Objective To evaluate the preventive effect of flurbiprofen axetil and small-dose ketamine on remifentanil-induced postoperative hyperalgesia. Methods Sixty ASA Ⅰ or Ⅱ surgical patients aged 18 to 70 years old were randomly assigned to three groups. All patients received total intravenous anesthesia with remifentanil （0.3μg·kg^-1·min^-1） and propofol during operations,and patient-controlled intravenous analgesia （PCIA） with tramadol after operations. Ketamine 0.5 mg/kg was given just after anesthesia induction, which was followed by 5 μg·kg^-1·min^-1 infusion until skin closure in groug Ⅰ. Flurbipr/ofen axetil 100 mg was injected before operation in group Ⅱ. Group Ⅲ received neither ketamine nor flurbiprofen as the control. Results The visual analog scors （VAS） at 1,2,4,8 h and frequencies of additional narcotic analgesic administration after operations were higher in group Ⅲ than those in the other two groups （P〈 0.05 or P〈 0.01）. Conclusion Remifentanil-induced postoperative hyperalgesia can be prevented effectively by flurbiprofen axetil preemptive administration or small-dose ketamine infusion without affecting recovery or increasing adverse effects.

关 键 词：氟比洛芬酯 氯胺酮 雷米芬太尼 痛觉过敏 

分 类 号：R614[医药卫生—麻醉学]