舒芬太尼防治瑞芬太尼复合麻醉的术后急性疼痛

Application of sufentanil to prevent acute postoperative pain in remifentanil-based anaesthesia

目的:研究舒芬太尼(0.5μg/kg)防治瑞芬太尼复合麻醉术后急性疼痛的临床疗效.方法:胸科、腹部和脊柱手术的患者90例(每类手术30例),随机分为芬太尼+可赛风组和舒芬太尼组,每组45例.舒芬太尼组和芬太尼+可赛风组分别于手术结束前25 min静脉滴注舒芬太尼(0.5μg/kg)或可赛风(8 mg)+芬太尼(1μg/kg).所有患者在手术结束前10 min停止吸入异氟醚,手术结束时停止泵注异丙酚和瑞芬太尼.比较两组患者自主呼吸恢复、意识恢复和拔管时间,以及患者恢复期的疼痛程度和拔管后需要追加芬太尼的例数.结果:芬太尼+可赛风组和舒芬太尼组患者的自主呼吸恢复时间、意识恢复时间和拔管时间在统计学上没有显著性差异.舒芬太尼组胸部和腹部手术后发生中等和严重疼痛的人数明显少于芬太尼+可赛风组(P<0.01),而且舒芬太尼组拔管后需要2次追加芬太尼的人数也少于芬太尼+可赛风组(P<0.05),后者约有30%的患者拔管后需要追加芬太尼.结论:手术结束前25 min静脉用舒芬太尼(0.5μg/kg)能够防治胸部、腹部和脊柱手术停止麻醉后因超短效阿片类药物瑞芬太尼的快速代谢而引起的术后急性疼痛,并且促进自主呼吸恢复和意识恢复.

AIM： To investigate the postoperative analgesic effect of sufentanil used in remifentanil-based anaesthesia with isoflurane and propofol. METHODS： Ninety patients undergoing major abdominal surgery, thoracic surgery or spine surgery respectively （n = 30 in each group ） were randomly assigned to sufentanil group and fentanil ＋ lomoxicam group, which received intravenous instillation of sufentanil （0.5 μg/kg） and fentanil （1 μg/ kg） ＋ lomoxicam（ 8 mg） respectively 25 min before the end of the operation. Isoflurane was switched off 10 min before the end of surgery. And after skin closure, remifentanil and propofol were switched off. Time to resumption of spontaneous respiration, eye opening and extubation were recorded, and pain was evaluated and the number of the patients who needed the second dose of fentanil was recorded. RESULTS： There were no significant differences in the time to resumption of spontaneous respiration, eye opening and extubation between sufentanil group and fentanil ＋ lomoxicam group. The patients having moderate to severe pain in sufentanil group was fewer than fentanil ＋ lomoxicam group （P 〈 0.01 ）. In sufentanil group fewer patients required a second dose of opioid （P 〈0.01 ） , while more than 30% required a second dose of opioid after extubation in fentanil ＋ lomoxicam group. CONCLUSION ： Intraoperative administration of sufentanil （0.5 μg/kg） 25 min before the end of the operation can provide immefliate pain relief postoperativity without severe effects on recovery time in remifentanil-based anaesthesia.