瑞芬太尼对琥珀胆碱引起的肌纤维成束收缩和术后肌痛的影响  

Effect of remifentanil on succinylcholine-induced muscle fasciculation and myalgia

作　　者：徐文庆 覃静 徐威[2] 张弩[2] 

机构地区：[1]上海市金山区亭林医院麻醉科,上海201505 [2]复旦大学附属金山医院麻醉科

出　　处：《上海医学》2016年第2期98-100,共3页Shanghai Medical Journal

基　　金：上海市金山区科学技术创新资金项目资助(2014-3-28)

摘　　要：目的观察瑞芬太尼对琥珀胆碱引起的肌纤维成束收缩和术后肌痛的影响。方法选择择期在静吸复合麻醉下行支撑喉镜下声带显微手术的患者100例，年龄25-65岁，美国麻醉医师协会分级Ⅰ或Ⅱ级，随机分人瑞芬组和对照组，每组50例。两组患者均静脉注射芬太尼2μg／kg、丙泊酚2mg／kg和琥珀胆碱1．5mg／kg行麻醉诱导，瑞芬组在诱导前5min经静脉输注泵注射瑞芬太尼0．2μg／（kg·min），气管插管后两组均吸入七氟烷维持麻醉，静脉间断注射琥珀胆碱0．2mg／kg，瑞芬组术中维持静脉注射瑞芬太尼0．1-0．2μg／（kg·min）。观察息者注射琥珀胆碱后肌纤维成束收缩程度，记录琥珀胆碱的用量。术后24h随访患者肌痛发生情况。结果瑞芬组肌纤维成束收缩发生率为98％（49／50），对照组为96％（48／50），两组间的差异无统计学意义（P〉0．05），两组间肌纤维成束收缩分级的差异亦无统计学意义（P〉0．05）。瑞芬组术后肌痛发生率为42％（21／50），对照组为52％（26／50），两组问的差异无统计学意义（P〉0．05），两组间术后肌痛程度的差异亦无统计学意义（P〉0．05）。瑞芬组的琥珀胆碱用量为（1．830±0．232）mg／kg，显著少于对照组的（2．059±0．413）rag／kg（P〈0．01）。患者肌纤维成柬收缩与术后肌痛不相关（P〉0．05）。结论瑞芬太尼并不能降低琥珀胆碱引起的肌纤维成束收缩的发生率和减轻其严重程度，对术后肌痛的发生率和严重程度亦无明显影响，但能减少琥珀胆碱的用量。Objective To observe the effect of remifentanil on succinylcholine-induced muscle fasciculation and postoperative myalgia. Methods One hundred patients, aged from 25 to 65 years, American Society of Anesthesiologists （ASA） grade Ⅰ or Ⅱ, scheduled for the vocal cord surgery through suspension laryngoscopy were randomly divided into remifentanil group and control group （n = 50 each）. Anesthesia induction was conducted with fentanyl 2 μg/kg, propofol 2 mg/kg and succinylcholine i. 5 mg/kg. The anesthesia was maintained with sevoflurane and succinylcholine in both groups. Patients in the remifentanil group were pretreated with remifentanil 0.2 lag/（kg · min） 5 min before induction of anethesia, and given sequentially remifentanil 0.1 - 0.2 μg/（kg · min） during surgery. The fasciculation was observed and the consumption of succinylcholine was recorded. Myalgia was assessed in 24 h postoperatively. Results The incidence of muscle fasciculation was 98% （49/50） and 96% （48/50） in the remifentanil group and control group, respectively, and no significant difference was found （ P 〉 0. 05） ; Neither was the severity of fasciculation （ P 〉 0. 05）. The incidence of postoperative myalgia was 42% （21/50） and 52% （26/50） in the remifentanil group and control group, respectively, and no significant difference was found （P 〉 0. 05）. The consumption of succinylcholine in the remifentanil-group was （ 1. 830 ± 0. 232） mg/kg, which was significantly less than that in the control group （I-2. 059 -I- 0.413-] mg/kg, P〉0.01 ）. The fasciculation was not related to postoperative myalgia （ P 〉 0.05）. Conclusion Remifentanil can not reduce the incidence and severity of fasciculation, and will not obviously affect the incidence and severity of postoperative myalgia, but it can reduce the consumption of succinylcholine during laryngoscopy. （Shanghai Med J, 2016, 39= 98-100）

关 键 词：琥珀胆碱 瑞芬太尼 肌纤维成束收缩 术后肌痛 

分 类 号：R614[医药卫生—麻醉学]