舒芬太尼防治瑞芬太尼行胆囊腹腔镜术后爆发痛的临床观察

Application of sufentanil to prevent acute postoperative pain in laparoscopic cholecystectomy with remifentanil-based anesthesia

目的观察舒芬太尼防治瑞芬太尼麻醉行腹腔镜胆囊切除术后爆发痛的有效性和安全性。方法将40例患者随机分为舒芬太尼组(S组)和对照组(C组),每组20例。手术结束前30 min停用异氟醚、维库溴铵,手术结束时停用丙泊酚、瑞芬太尼,同时对S组患者静脉注射舒芬太尼0.1μg/kg。观察术后1 h(T1)、2 h(T2)、4 h(T3)、6 h(T4)、12 h(T5)、24 h(T6)的脉搏氧饱和度(SpO2)、心率(HR)、收缩压(SBP)、舒张压(DBP)数值及视觉模拟评分(VAS),记录恶心、呕吐、烦躁等并发症。结果 T1、T2、T3、T5时S组VAS评分显著低于C组(P<0.01),T4、T6时VAS评分低于C组(P<0.05),而各时点S组SpO2、HR、SBP、DBP与C组比较差异无统计学意义(P>0.05),在恶心、呕吐、烦躁等并发症方面与C组比较差异亦无统计学意义(P>0.05)。结论手术结束时静脉注射0.1μg/kg舒芬太尼能够有效防治瑞芬太尼麻醉后的术后爆发痛和痛觉过敏,镇痛效果良好且不影响苏醒质量,无呼吸抑制发生,是应用于腹腔镜胆囊切除术后安全、灵活、有效的镇痛方法。

Objective To observe the efficiency and safety of sufentanil which used in laparoscopic cholecystectomy with remifentanil-based anesthesia to prevent the acute postoperative pain.Methods Forty patients were randomly and blindly assigned to sufentanil group（group S） and non-sufentanil group（group C,20 cases in each group）.Suspended isoflurane and vecuronium 30 minutes before the end of surgery then stoped using propofol remifentanil at the end of surgery,while the former group was injected sufentanil with 0.1 μg/kg.VAS,SpO2,HR,SBP,DBP were observed at post-operative 1 h（T1）,2 h（T2）,4 h（T3）,6 h（T4）,12 h（T5）,24 h（T6）,recorded the complications of nausea,vomiting,irritability and so on.Results VAS of group S was significantly lower than that of group C at T1,T2,T3,T5（P〈0.01）,the VAS score was lower than that of group C at T4,T6（P〈0.05）,there was no significant difference between group S and group C in SpO2,HR,SBP,DPB at T1,T2,T3,T4,T5,T6（P〉0.05）,and there was no significant difference in nausea,vomiting,irritability in the two groups（P〉0.05）.Conclusion At the end of surgery,injected 0.1 μg/kg sufentanil to control the acute postoperative pain of remifentanil and hyperalgesia effectively,analgesia without affecting the awakening quality,no respiratory depression occurred,which is secure,flexible and effective analgesia after the laparoscopic cholecystectomy.