不同剂量瑞芬太尼对妇科腹腔镜术后患者痛觉过敏的影响
불동제량서분태니대부과복강경술후환자통각과민적영향
Effect of different doses remifentanil on gynecologic laparoscopic postoperative hyperalgesia
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2015年 3期 185-188 ,共4页

    种丽双%王震生%韩紫娜%李丽霞

    충려쌍%왕진생%한자나%리려하

    腹腔镜检查%镇痛%痛觉过敏%瑞芬太尼 腹腔鏡檢查%鎮痛%痛覺過敏%瑞芬太尼
    복강경검사%진통%통각과민%서분태니
    Laparoscopy%Analgesia%Hyperalgesia%Remifentanil
    目的 探讨不同剂量瑞芬太尼对妇科腹腔镜手术镇痛效果和对痛觉过敏的影响.方法 将90例妇科腹腔镜手术患者按随机数字表法分为A组、B组、C组,每组30例.麻醉诱导A组、B组采用静脉注射瑞芬太尼1.5μg/kg、丙泊酚2 mg/kg、顺阿曲库铵0.2 mg/kg,C组采用静脉注射芬太尼3μg/kg、丙泊酚2 mg/kg、顺阿曲库铵0.2 mg/kg;麻醉维持A组采用输注瑞芬太尼0.3μg/(kg·min),B组采用输注瑞芬太尼0.2μg/(kg· min),C组采用输注芬太尼2μg/kg.记录手术时间、麻醉时间、拔管时间和术中丙泊酚、瑞芬太尼(A组、B组)用量;记录术前及拔管后15、30、60、120、240 min疼痛视觉模拟评分(VAS);拔管后镇痛时间、镇痛例数及不良反应发生情况.结果 三组手术时间和麻醉时间比较差异无统计学意义(P＞0.05).A组、B组拔管时间明显短于C组[(5.9±2.7)、(6.1±2.3)min比(9.6±3.3) min」,A组丙泊酚用量明显少于B组、C组[(461.3±69.7) mg比(543.4±101.9)、(552.5±93.8) mg],A组瑞芬太尼用量大于B组[(1.12±0.33) mg比(0.71 ±0.11) mg],差异有统计学意义(P＜0.05).三组拔管后15、30、60、120、240 min VAS均较术前明显升高[A组:(7.3±1.2)、(7.4±1.3)、(6.5±0.8)、(4.5±0.6)、(4.1±0.3)分比(1.2±0.3)分,B组:(6.4±1.5)、(6.6±11)、(5.3±0.4)、(4.6±0.3)、(4.0±0.4)分比(1.5±0.4)分,C组:(3.4±0.5)、(4.2±0.8)、(4.1±0.6)、(3.8±0.7)、(3.8±0.6)分比(1.4±0.2)分],差异有统计学意义(P＜0.05).A组拔管后15、30、60 minVAS均明显高于B组,A组、B组拔管后15、30、60、120 min VAS均明显高于C组,差异有统计学意义(P＜0.05).三组拔管后240 min VAS比较差异无统计学意义(P＞0.05).A组、B组、C组镇痛例数分别为28、29、3例,镇痛时间分别为(16.1±4.6)、(17.9±5.8)、(68.5±10.1) min,三组比较差异有统计学意义(P＜0.05),A组与B组比较差异无统计学意义(P＞0.05),A组、B组与C组比较差异有统计学意义(P＜0.05).三组不良反应发生情况比较差异无统计学意义(P＞0.05),三组均未发生呼吸抑制.结论 妇科腹腔镜手术中,痛觉过敏程度与瑞芬太尼使用剂量有关.
    목적 탐토불동제량서분태니대부과복강경수술진통효과화대통각과민적영향.방법 장90례부과복강경수술환자안수궤수자표법분위A조、B조、C조,매조30례.마취유도A조、B조채용정맥주사서분태니1.5μg/kg、병박분2 mg/kg、순아곡고안0.2 mg/kg,C조채용정맥주사분태니3μg/kg、병박분2 mg/kg、순아곡고안0.2 mg/kg;마취유지A조채용수주서분태니0.3μg/(kg·min),B조채용수주서분태니0.2μg/(kg· min),C조채용수주분태니2μg/kg.기록수술시간、마취시간、발관시간화술중병박분、서분태니(A조、B조)용량;기록술전급발관후15、30、60、120、240 min동통시각모의평분(VAS);발관후진통시간、진통례수급불량반응발생정황.결과 삼조수술시간화마취시간비교차이무통계학의의(P＞0.05).A조、B조발관시간명현단우C조[(5.9±2.7)、(6.1±2.3)min비(9.6±3.3) min」,A조병박분용량명현소우B조、C조[(461.3±69.7) mg비(543.4±101.9)、(552.5±93.8) mg],A조서분태니용량대우B조[(1.12±0.33) mg비(0.71 ±0.11) mg],차이유통계학의의(P＜0.05).삼조발관후15、30、60、120、240 min VAS균교술전명현승고[A조:(7.3±1.2)、(7.4±1.3)、(6.5±0.8)、(4.5±0.6)、(4.1±0.3)분비(1.2±0.3)분,B조:(6.4±1.5)、(6.6±11)、(5.3±0.4)、(4.6±0.3)、(4.0±0.4)분비(1.5±0.4)분,C조:(3.4±0.5)、(4.2±0.8)、(4.1±0.6)、(3.8±0.7)、(3.8±0.6)분비(1.4±0.2)분],차이유통계학의의(P＜0.05).A조발관후15、30、60 minVAS균명현고우B조,A조、B조발관후15、30、60、120 min VAS균명현고우C조,차이유통계학의의(P＜0.05).삼조발관후240 min VAS비교차이무통계학의의(P＞0.05).A조、B조、C조진통례수분별위28、29、3례,진통시간분별위(16.1±4.6)、(17.9±5.8)、(68.5±10.1) min,삼조비교차이유통계학의의(P＜0.05),A조여B조비교차이무통계학의의(P＞0.05),A조、B조여C조비교차이유통계학의의(P＜0.05).삼조불량반응발생정황비교차이무통계학의의(P＞0.05),삼조균미발생호흡억제.결론 부과복강경수술중,통각과민정도여서분태니사용제량유관.
    Objective To explore the effect of different doses remifentanil on hyperalgesia and the analgesic effect of gynecological laparoscopic operation.Methods Ninety gynecologic laparoscopic operation patients were divided into A group,B group and C group by random digits table method with 30 cases each.The anesthesia induction in A group and B group was intravenous injection remifentanil 1.5 μ g/kg,propofol 2 mg/kg,cisatracurium 0.2 mg/kg,and in C group was intravenous injection fentanyl 3 μ g/kg,propofol 2 mg/kg,cisatracurium 0.2 mg/kg.The maintenance of anesthesia in A group was infusion of remifentanil 0.3 μ g/ (kg· min),in B group was infusion of remifentanil 0.2 μ g/ (kg· min),and in C group was infusion of fentanyl 2 μ g/kg.The operation time,anesthesia time,time to extubation,intraoperative doses of propofol and remifentanil (A group and B group) were recorded.The visual analogue score (VAS) before operation and 15,30,60,120,240 min after extubation were recorded.The analgesia time,number of analgesia and adverse reaction after extubation were observed.Results There were no statistical differences in operation time and anesthesia time among 3 groups (P ＞ 0.05).The extubation time in A group and B group was significantly shorter than that in C group:(5.9 ± 2.7) and (6.1 ± 2.3) min vs.(9.6 ± 3.3) min,the dose of propofol in A group was significantly lower than that in B group and C group:(461.3 ± 69.7) mg vs.(543.4 ± 101.9) and (552.5 ± 93.8) ng,the dose of remifentanil in A group was significantly higher than that in B group:(1.12 ± 0.33) mg vs.(0.71 ± 0.1 l) mg,there were statistical differences (P＜ 0.05).The VAS 15,30,60,120,240 min after extubation in 3 groups were significantly higher than those before operation,A group:(7.3 ± 1.2),(7.4 ± 1.3),(6.5 ± 0.8),(4.5 ± 0.6),(4.1 ± 0.3) scores vs.(1.2 ± 0.3) scores,B group:(6.4 ± 1.5),(6.6 ± 1.1),(5.3 ± 0.4),(4.6 ± 0.3),(4.0 ± 0.4) scores vs.(1.5 ± 0.4) scores,C group:(3.4 ± 0.5),(4.2 ± 0.8),(4.1 ± 0.6),(3.8 ± 0.7),(3.8 ± 0.6) scores vs.(1.4 ± 0.2) scores,there were statistical differences (P ＜ 0.05).The VAS 15,30,60 min after extubation in A group were significantly higher than those in B group,and the VAS 15,30,60,120 min after extubation in A group and B group were significantly higher than those in C group,there were statistical differences (P ＜ 0.05).There was no statistical difference in VAS 240 min after extubation among 3 groups (P ＞ 0.05).The number of analgesia in A group,B group and C group were 28,29 and 3 cases,and the analgesia time were (16.1 ± 4.6),(17.9 ± 5.8) and (68.5 ± 10.l) min,there were statistical differences (P＜ 0.05),there were no statistical differences between A group and B group (P＞ 0.05),and there were statistical difference between A group,B group and C group (P ＜ 0.05).There was no statistical difference in adverse reaction among 3 groups (P ＞ 0.05),and there was no respiratory depression in 3 groups.Conclusion The degree of hyperalgesia is related to the dose of remifentanil during gynecologic laparoscopic operation.
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