芬太尼超前镇痛对瑞芬太尼恒速输注麻醉术后躁动的影响

The effect of postoperative agitation of fentanyl used for preemptive analgesia undergoing balance anesthesia with remifentanil at a constant rate infusion

目的观察在妇科手术中,不同剂量的芬太尼超前镇痛对丙泊酚联合瑞芬太尼恒速输注麻醉术后躁动的影响。方法 ASAⅠ～Ⅱ级择期行妇科手术的患者120例,随机分为3组,每组40例。每组在完成麻醉诱导及气管插管后,切皮前再静脉注射:A组生理盐水4 ml,B组芬太尼2μg/kg,C组芬太尼6μg/kg。各组麻醉维持:丙泊酚3～5 mg/kg/h,瑞芬太尼0.1～0.2μg/kg/min,维库溴铵间断静脉注射。记录各组血流动力学的变化,手术时间,术后躁动的评分,术后2、4、8、24 h疼痛视觉模拟评分(VAS)。结果 C组拔管时的血流动力学较A、B组更趋稳定,术后躁动的评分C组明显低于A、B组(P﹤0.01),术后2、4、8 h疼痛视觉模拟评分C组较A、B组更低(P﹤0.05),但24 h疼痛视觉模拟评分3组差异无统计学意义。结论大剂量的芬太尼超前镇痛对丙泊酚联合瑞芬太尼恒速输注麻醉能减少术后躁动的发生,缓解术后疼痛。

Objective To evaluate the effect of postoperative agitation of fentanyl using different doses for preemptive analgesia undergoing balance anesthesia with remifentanil combined propofol at a constant rate infusion in gynecological surgery. Methods All 120 patients （ ASA Ⅰ-Ⅱ） scheduled for gynecological surgery were randomly divided into three groups, with 40 patients in each group. After induction and intubation, the normal saline 4ml, fentanyl 2 ug/kg and fentanyl 6ug/kg were injected transvenously in group A, B and C re- spectively before skin incision. Propofol 3 - 5 mg/kg/h and remifentanil 0.1 - 0.2 ug/kg/min were continuously and transvenously infused for anesthesia maintaining in each group. Veeuronium was injected intermittently if necessary. The change of hemodynamics, operation time, the score of postoperative agitation, and the VAS of postoperative 2, 4, 8, 24 h were recorded. Results The hemodynamics was stable at the time of extubation in group C compared with group A and B. There was statistical difference compared with the score of postoperative agitation between group C and group A and B （ P 〈 0.01 ）. The VAS was lower in group C than group A and B at the time of postoperative 2, 4, 8 h （ P 〈 0.05 ）, but there was no statistical difference in three groups at the time of postoperative 24 h. Conclusion The large dosege fentanyl used for preemptive analgesia undergoing balance anesthesia with remifentanil combined propofol at a constant rate infusion could reduce the rate of postoperative agitation and moderate postoperative pain.