预先注射帕瑞昔布对不同剂量瑞芬太尼麻醉后痛觉过敏的影响

Influence of pretreated parecoxib on hyperalgesia after anesthesia by different doses of remifentanil

目的研究预先注射帕瑞昔布预防不同剂量瑞芬太尼麻醉后痛觉过敏的临床疗效。方法全身麻醉下行开腹子宫切除术患者分为2组(均n=20):小剂量瑞芬太尼组(S组)和大剂量瑞芬太尼组(L组)。2组均于麻醉诱导前30 min由静脉给予帕瑞昔布40 mg,S组和L组分别以血浆靶浓度2μg.L-1和4μg.L-1靶控输注瑞芬太尼,然后靶控输注丙泊酚(血浆靶浓度4 mg.L-1)行麻醉诱导和维持。患者在麻醉恢复室(PACU)应用视觉模拟评分法(VAS)进行疼痛评分,若VAS评分≥4分,静脉注射吗啡2 mg,5 min后可重复,直至VAS评分<4分。PACU停留观察2 h,送返病房后患者行静脉自控镇痛(PCIA)。记录VAS评分≥4分时间,第1次≥4分的VAS评分,静脉注射吗啡后VAS评分<4分所需时间,PACU中吗啡总用量,术后15 min～2 h及4、12、24、36、48 h VAS评分和PCIA吗啡用量,并观察麻醉苏醒期不良反应。结果与L组比较,S组术后VAS评分≥4分的时间延长[(33±s 8)min vs.(25±9)min,P<0.05],VAS评分<4分时间缩短[(3.7±2.8)min vs.(6±3)min,P<0.05],PACU中静脉吗啡用量减少[(9±6)mg vs.(16±9)mg,P<0.01],术后30、45、60、90、120 min的VAS评分降低(P<0.05或P<0.01)。2组不良反应发生率无显著差异(P>0.05)。结论预先注射帕瑞昔布缓解小剂量瑞芬太尼麻醉后痛觉过敏比大剂量效果更好。

AIM To investigate the influence of pretreated parecoxib on hyperalgesia after anesthesia by different doses of remifentanil.METHODS Female patients undergoing abdominal hysterectomy with general anesthesia were divided into small-dose（S group）and large-dose（L group）remifentanil group（n = 20 for each）with target plasma concentration 2 μg·L-1 and 4 μg·L-1 respectively.All patients pretreated with parecoxib 40 mg 30 min before anesthesia.Anesthesia was induced and maintained with iv infusion of remifentail at target plasma concentration 2 μg·L-1 or 4 μg·L-1 and propofol at target plasma concentration 4 mg·L-1.In post-anesthesia care unit（PACU）,morphine 2 mg was given if patient＇s visual analogue scores（VAS）≥ 4 and it can be repeated 5 min later until VAS 4.The patients were placed in PACU for 2 h after operation and then transported to the ward using patient-controlled intravenous anagesia（PCIA）by themselves.The following events were recored：the time from the end of operation to the patient＇s first VAS ≥ 4,the score when the patient＇s first VAS ≥ 4,the time from the administration of morphine to VAS 4,the total amount of morphine consumed in PACU,the VAS scores at 15 min-2 h and 4,12,24,36,48 h after operation,the morphine consumption in PCIA,and adverse reactions.RESULTS Compared with group L,the time from the end of operation to the patient＇s first VAS ≥ 4 was prolonged（（33 ± s 8）min vs.（25 ± 9）min,P 0.05）,the time to VAS 4 was shortened（（3.7 ± 2.8）min vs.（6 ± 3）min,P 0.05）,the morphine consumption in PACU decreased（（9 ± 6）mg vs.（16 ± 9）mg,P 0.01）,and VAS scores at 30,45,60,90,120 min decreased in group S（P 0.05 or P 0.01）.There was no significant difference in adverse reaction rate between the two groups（P 0.05）.CONCLUSION The pretreated parecoxib to prevent hyperalgesia after anesthesia of remifentanil were more effective in small-dose remifentanil compared with large-dose remifentanil.