CAJ | 학술논문

目的探讨帕瑞昔布钠对瑞芬太尼复合麻醉诱发患者术后痛觉过敏的影响.方法择期腹腔镜手术患者100例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄21～64岁,体重50～80 kg,采用随机数字表法,将其随机分为5组(n=20):帕瑞昔布钠组(P组)、小剂量瑞芬太尼组(S组)、大剂量瑞芬太尼组(L组)、小剂量瑞芬太尼+帕瑞昔布钠组(SP组)和大剂量瑞芬太尼+帕瑞昔布钠组(LP组).P组、LP组和SP组麻醉前30 min时静脉注射帕瑞昔布钠40mg.依次静脉注射咪达唑仑、依托咪酯、顺阿曲库铵和瑞芬太尼(P组芬太尼)麻醉诱导.麻醉维持:S组和SP组静脉输注瑞芬太尼0.05μg· kg-1 ·min-1,L组和LP组静脉输注瑞芬太尼0.3μg·kg-1 ·min-1,各组均复合吸入七氟醚,静脉输注顺阿曲库铵.于术后30 min时采用数字评分法(NRS)评估静态和动态切口疼痛程度,术后镇痛的辅助措施采用静脉注射曲马多1.5 mg/kg,维持NRS评分≤5分.记录术后24h内曲马多使用情况和不良反应发生情况.结果与P组比较,S组和L组术后30 min时静态和动态NRS评分升高,L组寒颤发生率和曲马多使用率升高(P＜0.05),SP组和LP组术后30 min时静态和动态NRS评分、不良反应发生率和曲马多使用率差异无统计学意义(P＞0.05)；与S组比较,L组术后30min时静态和动态NRS评分、寒颤发生率和曲马多使用率升高,SP组术后30 min时静态和动态NRS评分降低(P＜0.05),不良反应发生率和曲马多使用率差异无统计学意义(P＞0.05)；与L组比较,LP组术后30 min时静态和动态NRS评分、寒颤发生率和曲马多使用率降低(P＜0.05).结论麻醉前30 min静脉注射帕瑞昔布钠40mg可抑制瑞芬太尼复合麻醉诱发患者术后痛觉过敏.
목적 탐토파서석포납대서분태니복합마취유발환자술후통각과민적영향.방법 택기복강경수술환자100례,성별불한,ASA분급Ⅰ혹Ⅱ급,년령21～64세,체중50～80 kg,채용수궤수자표법,장기수궤분위5조(n=20):파서석포납조(P조)、소제량서분태니조(S조)、대제량서분태니조(L조)、소제량서분태니+파서석포납조(SP조)화대제량서분태니+파서석포납조(LP조).P조、LP조화SP조마취전30 min시정맥주사파서석포납40mg.의차정맥주사미체서륜、의탁미지、순아곡고안화서분태니(P조분태니)마취유도.마취유지:S조화SP조정맥수주서분태니0.05μg· kg-1 ·min-1,L조화LP조정맥수주서분태니0.3μg·kg-1 ·min-1,각조균복합흡입칠불미,정맥수주순아곡고안.우술후30 min시채용수자평분법(NRS)평고정태화동태절구동통정도,술후진통적보조조시채용정맥주사곡마다1.5 mg/kg,유지NRS평분≤5분.기록술후24h내곡마다사용정황화불량반응발생정황.결과 여P조비교,S조화L조술후30 min시정태화동태NRS평분승고,L조한전발생솔화곡마다사용솔승고(P＜0.05),SP조화LP조술후30 min시정태화동태NRS평분、불량반응발생솔화곡마다사용솔차이무통계학의의(P＞0.05)；여S조비교,L조술후30min시정태화동태NRS평분、한전발생솔화곡마다사용솔승고,SP조술후30 min시정태화동태NRS평분강저(P＜0.05),불량반응발생솔화곡마다사용솔차이무통계학의의(P＞0.05)；여L조비교,LP조술후30 min시정태화동태NRS평분、한전발생솔화곡마다사용솔강저(P＜0.05).결론 마취전30 min정맥주사파서석포납40mg가억제서분태니복합마취유발환자술후통각과민.
Objective To investigate the effect of parecoxib on postoperative hyperalgesia induced by remifentanil-based anesthesia.Methods One hundred ASA Ⅰ or Ⅱ patients,aged 21-64 yr,weighing 50-80 kg,undergoing elective laparoscopic operation,were randomly divided into 5 groups ( n =20 each):parecoxib group (group P),small dose remifentanil group (group S),large dose remifentanil group (group L),small dose remifentanil + parecoxib group (group SP) and large dose remifentanil + parecoxib group (group LP).Parecoxib 40 mg was injected intravenously at 30 min before anesthesia in groups P,SP and LP.Anesthesia was induced with midazolam0.05 mg/kg,etomidate 0.2 mg/kg,cisatracurium 0.15 mg/kg and remifentanil 1 μg/kg (fentanyl 4 μg/kg in group P).The patients was tracheal intubated and mechanically ventilated.PETCO2 was maintained at 35-45 mm Hg.Anesthesia was maintained with infusion of remifentanil at 0.05 μg·kg-1 ·min-1 (in groups S and SP) or at 0.3 μg· kg- 1· min- 1 (in groups L and LP) combined with inhalation of sevoflurane and infusion of cisatracurium at 0.12 mg·kg-1·h-1.At 30 min after operation,numeric rating scale (NRS) was used to assess the degree of pain at rest and during activity.Tramadol 1.5 mg/kg was injected intravenously after operation if needed.NRS scores were maintained ≤5.The use of tramadol and adverse effects during 24 h after operation were recorded.Results Compared with group P,NRS scores at rest and during activity were significantly increased at 30 min after operation in groups S and L,the incidence of shivering and the number of patients who needed tramadol were significantly increased in group L,and no change was found in NPS scores at rest and during activity at 30 min after operation,the incidence of adverse effects and the number of patients who needed tramadol in groups SP and LP.Compared with group S,NRS scores at rest and during activity at 30 min after operation,the incidence of shivering and the number of patients who needed tramadol were significantly increased in group L,NRS scores at rest and during activity at 30 min after operation were significantly decreased and no change was found in the incidence of adverse effects and the number of patients who needed tramadol in group SP.Compared with group L,NRS scores at rest and during activity at 30 min after operation,the incidence of shivering and the number of patients who needed tramadol were significantly decreased in group LP.Conclusion Intravenous injection of parecoxib 40 mg at 30 min before anesthesia can attenuate postoperative hyperalgesia induced by remifentanil-based anesthesia.