舒芬太尼复合帕瑞昔布钠预防瑞芬太尼麻醉后痛觉过敏的效果观察  

Preventive effect of sufentanil combined with parecoxibo on postoperative hyperalgesia induced by remifentanil

作　　者：白洁[1] 李卫松 孟丽华[1] 张蓬勃[1] BAI Jie;LI Weisong;MENG Lihua;ZHANG Pengbo(Department of Anesthesiology,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an,Shaanxi 710004,China)

机构地区：[1]西安交通大学第二附属医院麻醉科

出　　处：《安徽医药》2020年第3期569-572,共4页Anhui Medical and Pharmaceutical Journal

基　　金：陕西省重点研发计划项目(2017SF-086)

摘　　要：目的探究舒芬太尼与帕瑞昔布钠对瑞芬太尼术中镇痛后痛觉过敏的预防效果。方法选取2017年6月至2018年6月在西安交通大学第二附属医院择期全麻下行妇科开腹手术的病人60例,根据随机数字表法分成两组,A组:舒芬太尼+帕瑞昔布钠组30例,B组:舒芬太尼组30例。两组病人均采用气管插管全麻,A组于手术终止前30 min静注舒芬太尼5μg,帕瑞昔布钠40 mg;B组于手术终止前30 min静注舒芬太尼10μg;记录所有病人的手术用时和苏醒用时。于拔管后即刻、术后30、60、90 min对病人进行Ramsay镇静程度评分、BCS舒适度评分并VAS疼痛视觉模拟评分评估病人疼痛程度,记录术后不良反应及追加镇痛药品情况。结果A组病人Ramsay评分在拔管即刻(2.5±0.3)分及术后30 min(2.0±0.2)分低于B组(3.8±0.2)分、(3.2±0.3)分(P<0.05);A、B两组之间各时间点VAS评分差异无统计学意义(P>0.05);A组病人BCS评分在拔管后即刻(2.1±0.4)分、术后30 min(2.4±0.5)分、60 min(2.3±0.4)分、90 min(2.1±0.5)分高于B组(2.0±0.6)分、(2.3±0.4)分、(2.2±0.3)分、(2.2±0.4)分,差异有统计学意义(P<0.05);A组病人术后头晕4例,及追加药物人次3人次少于B组13例和10人次(P<0.05);B组苏醒用时(10.2±2.9)min比A组(7.6±3.3)min显著延长(P<0.05),两组病人均无嗜睡、寒战、低血压、心动过缓等术后不良反应。结论联合应用舒芬太尼和帕瑞昔布钠预防术后痛觉过敏,病人舒适度高,镇痛效果更好。Objective To evaluate the preventive effect of parecoxibo combined with sufentanil on remifentanil induced postoperative hyperalgesia.Methods Sixty patients undergoing elective gynecological laparotomy from June 2017 to June 2018 in The Second Affiliated Hospital of Xi’an Jiaotong University were selected and randomly allocated into 2 groups(n=30 each):sufentanil+parecoxibo group(group A),sufentanil group(group B).All the patients in the two group had a general anesthesia.In group A,parecoxibo 40 mg and sufentanil 5μg were infused at 30 min before the end of operation.In group B,sufentanil 10μg was infused at 30 min before the end of operation.Operation and awakening time was recorded.Ramsay score,VAS score,BCS score were recorded immediately and at 30,60,90 min after extubation.Postoperative adverse reactions and additional analgesics were recorded.Results The Ramsay score in group A immediately(2.5±0.3)and at 30 min after extubation(2.0±0.2)were lower than those in group B(3.8±0.2),(3.2±0.3)(P<0.05);There was no significant difference in VAS score between A and B group(P>0.05);The BCS score were higher in group A immediately(2.1±0.4),and at 30 min(2.4±0.5),60 min(2.3±0.4),90 min(2.1±0.5)after extubation than those in group B(2.0±0.6),(2.3±0.4),(2.2±0.3),(2.2±0.4)(P<0.05);There were 4 cases of postoperative dizziness and 3 cases of additional medication in group A,which were less than 13 cases and 10 cases in group B(P<0.05).The wake time in group B(10.2±2.9)were longer than that in group A(7.6±3.3)min(P<0.05).Conclusion Combined use of sufentanil and parexib sodium to prevent postoperative hyperalgesia resulted in high comfort and better analgesic effect.

关 键 词：疼痛 手术后 安定镇痛 帕瑞昔布纳 舒芬太尼 瑞芬太尼 痛觉过敏 

分 类 号：R614[医药卫生—麻醉学]