多模式超前镇痛在妇科腹腔镜手术中的应用  

Effect of preemptive multimodal analgesia( PMMA) in patients undergoing gynaecological laparoscopic surgery

作　　者：王瑞明[1] 柴小青[1] 陈昆洲[1] 

机构地区：[1]安徽省立医院急救中心麻醉科,安徽合肥230001

出　　处：《安徽医药》2015年第1期87-90,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的：探讨多模式超前镇痛在妇科腹腔镜手术的术后镇痛作用。方法80例择期行妇科腹腔镜手术患者，ASAⅠ～Ⅱ级，年龄25～64岁，随机双盲分为对照组（C 组）、地佐辛组（D 组）、帕瑞昔布钠组（P 组）、多模式镇痛组（PM组），每组20例，分别于麻醉诱导前5 min 给予生理盐水、地佐辛10 mg、帕瑞昔布钠40 mg 及地塞米松10 mg、地佐辛10 mg，复合帕瑞昔布钠40 mg 静脉注射。各组麻醉维持采用异丙酚和瑞芬太尼静脉麻醉，统计各组术中瑞芬太尼用量（RFC），记录术后患者拔除喉罩后0、1、2、4、8、12、24 h（T 1－7）的疼痛视觉模拟评分（VAS 评分），记录术后各组补救镇痛的时间和剂量，观察术后不良反应。结果C 组术中瑞芬太尼用量多于其他各组。拔除喉罩后0、1、2、4、8、12 h 的 VAS 评分，D 组、P 组均低于 C 组（P ＜0．05），PM组低于 D 组、P 组、C 组（P ＜0．05）。各组中患者于拔出喉罩后1、2、4 h 需要补救镇痛的例数，C 组多于 D 组、P 组（P ＜0．05），而 PM组不需要补救镇痛（P ＜0．05）。其他不良反应无明显差异。结论多模式超前镇痛在妇科腹腔镜手术有更好的镇痛效果，明显优于单一用药。Objective To determine the effect of preemptive multimodal analgesia in the patients undergoing gynaecological laparoscop-ic surgery.Methods Eighty patients aged 25 to 64 years old,ASAⅠ ~Ⅱ,undergoing selective gynaecological laparoscopic surgery were prospectively,randomly and double-blinded assigned into four groups （n =20）,control group （C group）,dezocine group （D group）,parecoxib group （P group）and preemptive multimodal analgesia group （PMgroup）.C group was given normal saline intrave-nously,D group dezocine 10mg,P group parecoxib 40 mg and PMgroup ezocine 10 mg plus parecoxib 40 mg plus dexamethasone10 mg 5 minutes before induction.The anesthesia was maintained with intravenous propofol and emifentanil.The average of remifentanil con-sumption was counted.The VAS scales were recorded 0,1,2,4,8,12,24 h（T 1 -7）after extubation.The induction and postoperative complications were recorded.Results The average remifentanil consumption（RFC）of C group was higher than the other three groups. VAS scales of D group and P group were lower than C group’s（P 〈0.05）and the VAS scales of PMgroup were lower than D group’ s,P group’s and C group’s at the time of 0、1、2、4、8、12 h after extubation（P 〈0.05）.More patients in C group needed rescue anes-thetics 1,2 or 4 h after extubation than D,T group’s,and patients in PMgroup didn’t need any rescue anesthetics （P 〈0.05）.There was no difference in other complications between the four groups.Conclusions The preemptive multimodal analgesia was more effec-tive than preemptive analgesia with single analgesic in laparoscopic cholecystectomy.

关 键 词：地佐辛 帕瑞昔布钠 地塞米松 多模式超前镇痛 妇科腹腔镜手术 

分 类 号：R614[医药卫生—麻醉学]