帕瑞昔布钠复合舒芬太尼对瑞芬太尼致腹腔镜手术患者痛觉过敏的影响

Enffects of parecoxib and sufentanil on remifentanil- induced postoperative hyperalgesia in patients undergoing laparoscopic surgery

目的 探讨帕瑞昔布钠复合舒芬太尼对瑞芬太尼致腹腔镜手术患者术后痛觉过敏的影响.方法 择期拟行腹腔镜手术患者120例,ASA分级Ⅰ或Ⅱ级,年龄20～65岁,体重45～85 kg,随机分为3组（每组n=40）.静脉注射咪达唑仑、异丙酚、瑞芬太尼和罗库溴铵麻醉诱导,气管插管后行机械通气.气管插管完成后,S组静脉注射舒芬太尼0.6 μg/kg;SP1组静脉注射帕瑞昔布钠20 mg和舒芬太尼0.3 μg/kg;SP2组静脉注射帕瑞昔布钠40 mg和舒芬太尼0.3 μg/kg.术中静脉输注异丙酚和瑞芬太尼,间断静脉注射维库溴铵维持麻醉.记录苏醒时间、意识恢复时间和拔管时间;记录拔管期间躁动和寒战的发生情况,以及意识恢复后5 min时的口述痛觉评分（VRS评分）.分别于术后1 （T1）、2 （T2）、4 （T3）、8（T4）、12（T5）和24 h（T6）时,采用VAS评分评价患者静态和动态的疼痛程度,同时记录平均动脉压（MAP）和心率（HR）.记录术后24 h内恶心呕吐的发生情况.结果 3组患者苏醒时间、意识恢复时间、拔管时间、VRS评分、MAP、HR、躁动、寒战和恶心呕吐发生率比较差异无统计学意义（P＞0.05）.与S组比较,SP1组T1～2时静态VAS评分升高,T1～6时动态VAS评分升高,SP2组T1～5时静态和动态VAS评分降低（P＜0.05）;与SP1组比较,SP2组T1～6时静态VAS评分降低,T1～5时动态VAS评分降低（P＜0.05）.结论术前静脉注射帕瑞昔布钠40 mg复合舒芬太尼0.3 μg可减轻瑞芬太尼致腹腔镜手术患者术后痛觉过敏,且效果优于单独应用舒芬太尼.

Objective To investigate the effects of pareeoxib and sufentanil on remifentanil - induced postoperative hyperalgesia in patients undergoing laparoscopic surgery. Methods One hundred twenty ASA Ⅰ or Ⅱ patients, aged 20 - 65 years weighing 45 - 85 kg , undergoing laparoscopic surgery, were randomly divided into 3 groups （ n = 40 each）. Anesthesia was induced with midthazolam, propofol, remifentanil and racuronium. The patients were mechanically ventilated after tracheal intubation. Group Ⅰ received iv injection of sufentanil 0.6 μ/kg, group Ⅱ received iv injection of parecoxib 20 mg and sufentanil 0.3μg/kg and group Ⅲ received iv injection of parecoxib 40 mg and sufentanil 0.3 μg/ kg. Anesthesia was maintained with infusion of propofol and remifentanil and intermittent in boluses of vecuronium. The wake -up time, extubation time, incidence of agitation and shivering, and VRS score at 5 min after recovery of consciousness were recorded. Pain at rest and movement was evaluated using VAS score at 1,2,4,8,12 and 24h （T1 -6） after surgery and MAP and HR were recorded simultaneously. The incidence of nausea and vomiting during 24 h after surgery was also recorded. Results There were no significant differences in wake - up time, consciousness recorvery time, extubation time, VRS scores, MAP, HR, incidence of agitation, shivering, nausea and vomiting among the 3 groups （P 〉 0.05）. Compared with group Ⅰ , VAS scores at rest at T1 - 2 and at movement at T1 - 6 were cignifisantly increased in group Ⅱ , while VAS scores at rest and at movement decreased at T1 - 5 in group Ⅲ（ P 〈 0.05）. VAS scores at rest at T1 - 6 and at movement at T1 - 5 were significantly lower in group m than in group Ⅱ （P 〈 0.05 ）. Conclusion Pre- operative iv parecoxib 40 mg and sufentanil 0.3 μg/kg can reduce remifentanil - induced postoperative hyperalgesia in patients undergoing laparoscopic surgery, and the efficacy is better than that of sufentanil alone.