瑞芬太尼复合麻醉病人术后急性阿片类药物耐受发生的再评价

Re-evaluation of acute opioid tolerance in patients after remifentanil-based anesthesia

目的再评价瑞芬太尼复合麻醉病人术后急性阿片类药物耐受的发生情况。方法择期全麻下行脊柱外科手术病人90例，年龄18～64岁，ASAI或Ⅱ级，随机分为3组（n=30），吸人麻醉组（S组）吸入七氟烷麻醉诱导，吸入七氟烷及氧化亚氮维持麻醉；舒芬太尼组（SP组）靶控输注舒芬太尼和异丙酚诱导和维持麻醉，瑞芬太尼组（RP组）靶控输注瑞芬太尼和异丙酚诱导和维持麻醉。病人在麻醉恢复室停留1h，然后送返病房，在麻醉恢复室采用静脉注射吗啡镇痛，在病房采用病人自控静脉镇痛，镇痛泵内含0．5mg／ml吗啡，共100ml。记录术后10min、20min、30min、40min、50min、60min、2h、12h、24h、36h和48h时视觉模拟评分（VAS）和吗啡用量。结果与SP组和S组比较，术后1h内RP组VAS评分和吗啡用量增加（P〈0．05或0．01），术后2～48hVAS评分和吗啡用量差异无统计学意义（P〉0．05）。结论瑞芬太尼复合麻醉病人术后1h内存在急性阿片类药物耐受现象。

Objective To evaluate the acute opioid tolerance in patients after remifentanil-based anesthesia,Methods Ninety ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing spinal surgery under general anesthesia were randomly divided into 3 groups （ n = 30 each） ： group Ⅰ sevoflurane ＋ N20 （ S ） ; group sufentanil ＋ propofol （SP） and group Ⅲ remifentanil ＋ propofol （RP）. In group Ⅱ and Ⅲ sufentanil, remifentanil and propofol were administered by target-controlled infusion （TCI）. The patients were observed in PACU for 1 h after operation and then transferred to the ward. Pain was controlled by intermittent iv boluses of morphine in PACU and PCIA with morphine in the ward （background infusion 0.5 mg/h, bolus dose 1 mg, lockout interval 6 min）. VAS scores and morphine consumption were recorded at 10 min, 20 min, 30 min, 40 min, 50 min, 60 min, 2 h, 12 h, 24 h, 36 h and 48 h after operation. Results During the first hour after operation in PACU the VAS scores and morphine consumption were significantly higher in group RP than in group SP and S （ P 〈 0.05 or 0.01 ）. There was no significant difference in VAS scores and cumulative morphine consumption during the 2-48 h after operation in the ward among the 3 groups. Conclusion Remifentanil-based anesthesia induces acute opioid tolerance during the first hour after operation.