三种镇痛药抑制瑞芬太尼致痛觉过敏作用的比较  

Comparison of the effects of different analgesics in preventing postoperative hyperalgesia after remifentanil-based TIVA

作　　者：李芸[1] 李天佐[1] 纪方[1] 裴春明[1] 李梅[1] 

机构地区：[1]北京同仁医院麻醉科,100730

出　　处：《临床麻醉学杂志》2011年第10期944-946,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较三种中长效镇痛药舒芬太尼、曲马多和氟比洛芬酯在抑制瑞芬太尼全麻术后痛觉过敏中的作用。方法全麻择期中耳手术患者80例,随机分为:舒芬太尼组(S组)、曲马多组(T组)、氟比洛芬酯组(F组),分别于手术结束前30 min静注舒芬太尼0.1μg/kg、曲马多2 mg/kg、氟比洛芬酯1.5 mg/kg,对照组(C组)术中除瑞芬太尼外不给其它镇痛药物。记录四组患者一般情况、手术时间、丙泊酚和瑞芬太尼的泵入量、拔管时间、拔管后清醒时间及拔管后10、30 min、术后4、24 h的VAS评分。结果 S组拔管时间明显长于T组和C组(P<0.05)。拔管后10、30 min VAS评分S组和T组明显低于C组(P<0.05)。与拔管后10、30 min比较,术后4、24 h S组和T组VAS评分差异无统计学意义;F组和C组VAS评分明显降低(P<0.05);四组术后4、24 h的VAS评分差异无统计学意义。结论术中大剂量使用瑞芬太尼可诱发术后4 h内痛觉过敏,手术结束前给予舒芬太尼和曲马多可抑制痛觉过敏,氟比洛芬酯对痛觉过敏无明显抑制作用,舒芬太尼的应用可延长拔管时间。Objective To compare the effects of sulfentanil, tramadol and flurbiprofen in preventing postoperative hyperalgesia after remifentanil-based total intravenous anesthesia （TIVA）. Methods Eighty patients undergoing middle ear operations with remifentanil and propofol based TIVA were randomly assigned to 4 groups： group S （sufentanil）, group T （tramadol）, group F （flurbiprofen） and group C（control）. The patients were received sulfentanil 0.1 μg/kg, tramadol 2 mg/kg or flurbiprofen 1.5 mg/kg i. v. at 30 min before the end of operation, respectively. The dosages of narcotics during anesthesia, the extubation time and awareness time were recorded. The pain intensity was evaluated by vision assessment score （VAS） at the point of 10, 30 min, 4, Z4 hr after surgery. Results Compared with group T and C, the extubation time in S group was longer （P 〈0.05）. VAS scores in groups S and T were less than in groups C at 10, 30 min after extubation （P〈0.05）. When compared with the VAS within 4, 24 h of postoperation, the scores of VAS at the postoperative point of 10 rain and 30 min were significantly higher in the group F and C （P〈0. 05）. Conclusion Large dosages of remifentanil used during anesthesia may cause hyperalgesia after operation. Sulfentanil and tramadol not flurbiprofen can prevent hyperalgesia efficiently; but sulfentanil has longer recovery time.

关 键 词：瑞芬太尼 痛觉过敏 舒芬太尼 曲马多 氟比洛芬酯 

分 类 号：R614[医药卫生—麻醉学]