氟比洛芬酯复合地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果  

Efficacy of flurbiprofen axetii combined with dezocine in preventing postoperative hyperaigesia in patients undergoing remifentanii-based anesthesia

作　　者：张麟临 赵亓[1] 王新[1] 舒瑞辰 李伊泽 王春艳[1] 于泳浩[1] 王国林[1] 

机构地区：[1]天津医科大学总医院麻醉科天津市麻醉学研究所,300052

出　　处：《中华麻醉学杂志》2016年第4期392-395,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金（81571077,81371245,81400908）

摘　　要：目的探讨氟比洛芬酯复合地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果。方法择期全麻妇科腹腔镜手术患者100例，ASA分级Ⅰ或Ⅱ级，年龄20～60岁，体重48～70kg，采用随机数字表法分为4组（n=25）：对照组（C组）、氟比洛芬酯组（F组）、地佐辛组（D组）和氟比洛芬酯＋地佐辛组（F＋D组）。麻醉诱导前，F组静脉注射氟比洛芬酯2mg／kg，D组静脉注射地佐辛0．2mg／kg，F＋D组静脉注射氟比洛芬酯1mg／kg和地佐辛0．1mg／kg，C组给予等容量生理盐水。麻醉诱导：静脉注射咪达唑仑0．05mg／kg、舒芬太尼0．3μg／kg、异丙酚2．0mg／kg和顺式阿曲库铵0．2mg／kg，气管插管结束后连接呼吸机，行机械通气，维持PETCO235～45mmHg。麻醉维持：静脉输注瑞芬太尼0．3μg·kg-1·min-1和异丙酚4～6mg·kg-1·h-1维持BIS值40～60，间断静脉注射顺式阿曲库铵维持肌松。入PACU后行PCA，镇痛方案：舒芬太尼浓度1μg／ml，容量100ml，背景输注速率2ml／h，PCA剂量0．5ml，锁定时间15min。维持疼痛评分〈4分。记录瑞芬太尼输注时间。于术后0～1、1～6、6～12和12～24h时段记录舒芬太尼用量，并记录术后24h内恶心、呕吐、眩晕、嗜睡的发生情况。结果4组患者术后1h内舒芬太尼用量比较差异无统计学意义（P〉0．05）；与c组比较，F组、D组和F＋D组术后1～24h内舒芬太尼用量降低，F组恶心和呕吐的发生率升高，D组眩晕和嗜睡的发生率升高（P〈0．05），F＋D组不良反应发生率差异无统计学意义（P〉0．05）；F组、D组和F＋D组术后不同时段舒芬太尼用量比较差异无统计学意义（P〉0．05）。与F组比较，F＋D组恶心和呕吐的发生率降低（P〈0．05）；与D组比较，F＋D组眩晕和嗜睡的发生率降低（P〈0．05）。结论氟比洛芬酯复合地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果优于两Objective To investigate the efficacy of flurbiprofen axetil combined with dezocine in preventing postoperative hyperalgesia in the patients undergoing remifentanil-based anesthesia. Methods One hundred patients, of American Society of Anesthesiologist physical status Ⅰ or Ⅱ , aged 20-60 yr, weighing 48-70 kg, scheduled for elective gynecological laparoscopic surgery under general anesthesia, were randomly divided into 4 groups （n = 25 each） using a random number table： control group （ group C） ; flurbiprofen axetil group （ group F） ; dezocine group （ group D） ; flurbiprofen axetil plus dezocine group （group F＋D）. Before induction of anesthesia, flurbiprofen axetil 2 mg/kg, dezocine 0,2 mg/kg, and flurbiprofen axetil 1 mg/kg plus dezocine 0.1 mg/kg, were injected intravenously in F, D and F＋D groups, respectively, while the equal volume of normal saline was given in group C. Anesthesia was induced with intravenous injection of midazolam 0.05 mg/kg, sufentanil 0.3 i.~g/kg, propofol 2.0 mg/kg and cisatracurium 0.2 mg/kg. After tracheal intubation, the patients were mechanically ventilated, and end-tidal pressure of carbon dloxidewas maintained at 35-45 mmHg. Anesthesia was maintained with intravenous infusion of remifentanil 0.3 μg · kg-1· min-1 and propofol 4-6 mg·kg-1· h-1 , bispectral index value was maintained at 40-60, and muscle relaxation was maintained with intermittent iv boluses of cisatracurium. After admission to the postanesthesia care unit, patient-controlled analgesia was performed with sufentanil 1 μg/ml （ 100 ml）. The patient-controlled analgesia pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at a rate of 2 ml/h. Visual analogue scale score was main- tained less than 4. The time for remifentanil infusion was recorded. The consumption of sufentanil were recorded within 0-1, 1-6, 6-12 and 12-24 h periods after surgery, and the development of nausea, vomiting, dizziness and somnolence were also recorded wit

关 键 词：氟比洛芬 镇痛药 阿片类 哌啶类 痛觉过敏 手术后并发症 

分 类 号：R614[医药卫生—麻醉学]