小剂量氯胺酮与氟比洛芬预防瑞芬太尼麻醉患者术后痛觉过敏效果的比较

Comparison of preventive effects of flurbiprofen and low-dose ketamine on remifentanil-induced postoperative hyperalgesia

目的比较小剂量氯胺酮和氟比洛芬预防瑞芬太尼麻醉患者术后痛觉过敏的效果。方法择期行腹腔镜胆囊切除术患者80例，ASAⅠ或Ⅱ级，年龄18—59岁，性别不限，随机分为4组（n=20）：小剂量瑞芬太尼组（LR组）、大剂量瑞芬太尼组（HR组）、大剂量瑞芬太尼＋氯胺酮组（HRK组）、大剂量瑞芬太尼＋氟比洛芬组（HRF组）。LR组术中静脉输注瑞芬太尼0．05μg·kg^-1·min^-1，HR组、HRK组和HRF组静脉输注瑞芬太尼0．4μg·kg^-1·min^-1，4组均复合七氟醚维持麻醉。于开始分离胆管时HRK组静脉注射氯胺酮0．8mg／kg，HRF组静脉注射氟比洛芬1．5mg／kg。记录术后2h内和术后4、8、12、24及48h时VAS评分，术后2h和48h内哌替啶用量以及恶心、呕吐的发生情况。结果与HR组比较，LR组、HRK组和HRF组术后2h和48h内哌替啶用量均减少，术后2h内VAS评分降低（P〈0．05或0．01），术后4—48hVAS评分差异无统计学意义（P〉0．05）。与LR组比较，HRK组和HRF组术后2h和48h内哌替啶用量差异无统计学意义（P〉0．05），术后2h内VAS评分降低（P〈0．05）。HRK组和HRF组以上指标比较差异无统计学意义（P〉0．05）。结论小剂量氯胺酮和氟比洛芬预防瑞芬太尼麻醉患者术后痛觉过敏的效果确切且差别不明显。

Objective To compare the preventive effects of flurbiprofen and low-dose ketamine on remifentanil-induced postoperative hyperalgesia. Methods Eighty ASA Ⅰ or Ⅱ patients of both sexes aged 18-59 yr undergoing elective laparoscopic cholecystectomy （LC） were randomly divided into 4 groups （ n = 20 each） ： small-dose remifentanil group （LR）, large-dose remifentanil group （HR）, large-dose remifentanil ＋ ketamine group （HRK） and large-dose remifentanil ＋ flurbiprofen group （HRF）. In group LR, remifentanil 0.05 μg·kg^-1·min^-1 was infused intravenously. In group HR, HRK and HRF, remifentanil 0.4 μg·kg^-1·min^-1 was infused intravenously. In all groups, anesthesia was maintained with remifentanil in combination with sevoflurane. When the bile duct separation was started, ketamine 0.8 mg/kg and flurbiprofen 1.5 mg/kg were injected intravenously in group HRK and HRF respectively. VAS scores were recorded within 2 h and at 4, 8, 12, 24 and 48 h after operation. The amount of pethidine consumed and postoperative nausea and vomiting were also recorded within 2 and 48 h after operation. Results The amount of pethidine consumed was smaller within 2 and 48 h after operation and VAS scores were significantly lower within 2 h after operation in group LR, HRK and HRF than in group HR （ P 〈 0.05 or 0.01 ）. There were no significant differences in the amount of pethidine consumed within 2 and 48 h after operation between group HRK and HRF and group LR （ P 〉 0.05 ）, but VAS scores were significantly lower within 2 h after operation in group HRK and HRF than in group LR （ P 〈 0.05）. There were no significant differences in the indexes mentioned above between group HRK and HRF （ P 〉 0.05 ）. Conclusion Both flurbiprofen and low-dose ketamine have significant preventive effects on postoperative hyperalgesia induced by remifentanil with no difference between them.