地佐辛与曲马多和芬太尼预防全身麻醉后瑞芬太尼痛觉超敏反应效果的比较

Effect comparison of dezocine,tramadol and fentanyl on preventing remifentanil induced hyperalgesia after general anesthesia

目的 比较地佐辛与曲马多和芬太尼预防瑞芬太尼麻醉停药后痛觉超敏的效果.方法 择期妇科经腹手术患者90例,ASAⅠ-Ⅱ级,采取随机双盲法,所有患者分为A组（地佐辛组）、B组（曲马多组）、C组（芬太尼组）,每组30例.在手术结束前15 min,A组静脉注入地佐辛0.2 mg/kg,B组静脉注入曲马多2 mg/kg,C组注入芬太尼2 μg/kg.观察并记录三组麻醉苏醒时间和拔管时无创动脉压及心率;观察三组术后15 min、1 h、2 h、4 h、8 h、12 h、24 h各时段的疼痛评分（VAS评分）及镇静评分（Ramsay评分）;记录拔管期间躁动、呛咳、嗜睡和恶心呕吐的发生率.结果 A组麻醉苏醒时间较B、C组明显缩短（P〈0.05）;A组术后2、4、8、16、24 h时,VAS评分较B、C组明显降低（P〈0.05）;A组术后15 min、1 h、2 h时,Ramsay评分较B、C组高（P〈0.05）;A组术后不良反应发生率较B、C组明显降低（P〈0.05）.结论 地佐辛对全身麻醉后瑞芬太尼的痛觉超敏反应与芬太尼和曲马多比较有更好的防治作用,且不良反应发生率明显降低.

Objective To observe and compare the effects of dezocine, tramadol and fentanyl on preventing remifentanil in- duced hyperalgesia after discontinuation of anesthesia. Methods Ninety patients （ASA I - Ⅱ ） undergoing selective gynaecology abdominal operation were selected. Patients were divided into three groups by the double-blind method： gropu A （dezocine group）, group B （tramado｜ group） and group C （fentanyl group）, with 30 patients in each group. Group A were injected with dezocine at 15 minutes before the ending of surgery, the dose was O. 2 mg/kg; Group B were injected with Tramadol, the dose was 2 mg/kg; Group C were injected with fentanyl, the dose was 2 ixg/kg. The awake time,the tracheal extubation time, the ar- terial pressure and heart rate at the time of tracheal extubation were observed and recorded, the visal anaglogue scale （VAS） and Ramsay were recorded at the time of 15 minutes, 1 h, 2 h, 4 h, 8 h, 12 h, 24 h after the surgery, at the same time, the occurrence rates of adverse reaction such as dysphoria, bucking, drowsiness, nausea and vomiting were recorded. Results Compared with group B and C, the awake time and tracheal extubation time in group A was shorter（P 〈 0. 05 ） ; Compared with group B and C, at the time of 2 h, 4 h, 8 h, 16 h, 24 h, the VAS in group A was lower; at the time off5 min, 1 h, 2 h, Ramsay in group A was higher, and the occurrence rate of adverse reaction in group A was lower than that in group B and group C （ P 〈 0. 05 ）. Conclusion Dezocine is better on preventing hyperalgesia of remifentanil after general anesthesia, and the occurrence rate of adverse reaction is lower.