瑞芬太尼对术后镇痛效果的影响  

Influences of remifentanil on post-operative pain management

作　　者：俞红丽[1] 董榕[2] 薛庆生[2] 傅舒昆[1] 于布为[2] 

机构地区：[1]同济大学附属第十人民医院麻醉科,上海200072 [2]上海交通大学医学院附属瑞金医院麻醉科

出　　处：《上海医学》2009年第6期498-502,共5页Shanghai Medical Journal

基　　金：国家自然科学基金资助项目(30672020)

摘　　要：目的观察术中使用瑞芬太尼对于术后镇痛效果的影响,以期改善瑞芬太尼麻醉及其术后疼痛管理的质量。方法100例择期在全凭静脉麻醉下行妇科手术的患者,美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级,随机分为5组,每组20例。Ⅰ组,术中以芬太尼维持麻醉;Ⅱ、Ⅲ、Ⅳ、Ⅴ组分别在术中以瑞芬太尼0.05、0.15、0.25、0.35μg·kg-1.min-1维持麻醉的机械性。术前指导患者掌握疼痛视觉模拟评分(VAS评分)和术后患者自控镇痛(PCA)泵的使用。术后以vonFrey纤毛测定仪测定距离手术切口3cm处皮肤的机械性痛阈,以疼痛VAS评分评估疼痛程度。记录麻醉期间和术中、苏醒拔管后的循环指标,患者苏醒即刻、苏醒后30、60、90min以及2、4、6、24h的VAS评分和手术切口周围机械性痛阈值,以及术后24h吗啡用量和PCA泵使用情况。结果苏醒即刻,各组VAS评分均较术前显著增加(P值均<0.05),Ⅰ组显著低于其余4组(P值分别<0.05、0.01);苏醒后30min,Ⅱ组显著低于Ⅳ、Ⅴ组(P值均<0.01),Ⅲ组显著低于Ⅳ组(P<0.05)。苏醒即刻和苏醒后30、60、90min及2、4h,Ⅰ组机械性痛阈值均显著高于其余4组(P值分别<0.01、0.05);苏醒后6h,Ⅰ组显著高于Ⅲ、Ⅳ、Ⅴ组(P值分别<0.01、0.05)。Ⅱ、Ⅳ组苏醒后24h的吗啡消耗量显著多于Ⅰ组(P值均<0.05)。Ⅰ、Ⅱ组PCA按压次数显著少于Ⅲ、Ⅳ、Ⅴ组(P值均<0.01)。结论术中持续输注相对大剂量的瑞芬太尼可增加术后对疼痛的敏感性,使患者对术后镇痛药物的需求量增大。Objective To investigate the effect of intra-operative infusion of remifentanil on the postoperative pain management, so as to improve the quality of remifentanil anesthesia and its post-operative pain management. Methods One hundred women, American Society of Anesthesiologists （ASA） Ⅰ - Ⅱ , undergoing elective abdominal hysterectomy surgery with total intravenous general anesthesia were enrolled in this study. They were evenly randomized into five groups： group Ⅰ （fentanyl, as control ）, group Ⅱ （remifentanil 0.05 μg· kg^-1· min^-1 ）, group Ⅲ （ remifentanil 0.15 μg · kg^-1· min^-1 ）, group Ⅳ （ remifentanil 0.25 μg· kg^-1· min^-1）, and group V （remifentanil 0.351μg· kg^-1· min^-1）Before surgery all patients were instructed for the yon Frey hair of quantitative sensory test, the use of patient-controlled analgesia （PCA） pump and the pain measurement as visual analog scale （VAS）. yon Frey test was used to measure the pain threshold at a site 3 cm adjacent to the skin incision. During surgery, anesthesia was maintained with target controlled infusion （TOl） of propofol 3-6 μg/mL, atracurium 5-8 μg· kg^-1· min^-1 and opioids as mentioned above. All patients were given a bolus of 0.15 mg/kg morphine 30 min before the end of surgery. During the post-operative period, patient pain scores and von Frey hair test were evaluated immediately, and 30 min, 60 min, 90 min, 2 h, 4 h, 6 h, and 24 h after awake. Morphine consumption and numbers of POA bolus were recorded 24 h of the post-operation. Results The post-operative VAS scores were significantly higher in remifentanil group than in fentanyl group （P〈0.05 or 0.01 ）, especially at 30-60 min post-operative in group IV and V. Hyperalgesia indicated by von Frey hair stimulation adjacent to the surgical wound was more severe in remifentanil groups than in fentanyl group （P〈0.05 or 0.01）. Mean total morphine consumption was higher in group Ⅱ than in group Ⅰ （P〈0-05）. The numbers of bolus use o

关 键 词：瑞芬太尼 芬太尼 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]