喷他佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的临床研究

Clinical research of pentazocine on the prevention of postoperative hyperalgesia in patients after remifentanil -based anesthesia

目的评价喷他佐辛预防瑞芬太尼复合异丙酚全凭静脉麻醉患者术后痛觉过敏的临床效果。方法择期行子宫切除术患者100例，ASAⅠ-Ⅱ级，随机分为4组（n：25）：芬太尼组（F组），喷他佐辛0．2mg／kg组（P1组）、0．3mg／kg组（P2组）和0．4mg／kg组（P3组）。所有患者均采用瑞芬太尼复合异丙酚全凭静脉麻醉，静脉持续输注丙}白酚、瑞芬太尼、顺阿曲库铵维持麻醉。手术结束前15minP1组、P2组和P3组分别静脉注射喷他佐辛0．2、0．3、0．4mg／kg，F组静脉注射芬太尼1μg/kg。记录患者拔除气管导管的时间及此时的平均动脉压（MAP）和心率（HR）及苏醒时间，根据视觉模拟评分（VAS）表在苏醒后即刻（T0）、术后1h（T1）、术后2h（T2）进行评估并记录，同时记录拔除气管导管后呼吸抑制、恶心呕吐及尿潴留等不良反应发生情况。结果与F组比较，P1组、P2组和P3组苏醒时间和拔除气管导管时间明显缩短，呼吸抑制和恶心呕吐发生率降低（P〈0．05）；P1组各时间点VAS评分升高（P〈0．05），P2组和P3组T0时间点VAS评分略升高，T1、T2时VAS评分略降低，但差异无统计学意义（P〉0．05）；但P3组呼吸抑制发生率较P2组明显升高（P〈0．05）；4组患者无一例发生尿潴留。结论手术结束前15min静脉注射0．3mg／kg喷他佐辛可减轻瑞芬太尼复合麻醉患者麻醉恢复期痛觉过敏，且不良反应少。

Objective To evaluate the clinical efficacy of pentazocine on the prevention of postoperative hyperalgesia in patients after remifentanil - based anesthesia. Methods A total of 100 ASA Ⅰ-Ⅱ patients receiving laparoseopie hysterectomy were randomly divided into four groups （n = 25 ） ： a fentanyl group （group F） , a low - dose pentazocine group （ group P1 ） , a medium - dose pentazoeine group （ group P2 ） and a high - dose pentazoeine group （ group P3 ）. All patients were intravenously injected with remifentanil combined with propofol, while atracurium was adopted for anesthesia maintenance. Groups P1 , P2 and- P3 were intravenously injected with 0.2, 0.3, and 0.4 mg/kg of pentazoeine respec- tively 15 rain before the end of surgery, while group F were treated with 1 p.g/kg of fentanyl at the same time. Then, mean arterial pressure, heart rate, the awakening time and extubation time were recorded. The visual analog scale （VAS） was used to assess the time immediately （ T0 ）, 1 h （ T1 ） and 2 h （ T2 ） after awakening. Meanwhile, adverse reactions like respiratory depression, nausea and vomiting and urinary retention after extubation were recorded. Results Compared with group F, remarkably shortened awakening time and extubation time as well as lowered rates of respiratory depression, nausea and vomiting were observed in groups P1, P2 and P3- Increases were seen as to VAS score in group P1 （P 〈 0.05）. The VAS scores at TO in groups P2 and P3 were slightly raised, in comparison with slightly reduced VAS score at T1-2 in group P2 and P3 （ P 〉 0.05 ）. However, those in group P3 reported a striking higher rate of respiratory depression than those in group P2 （ P 〈 0.05 ）, No patient manifested urinary retention in all groups. Conclusion Intravenous injection of 0.3 mg/kg pentazocine 15 rain before the end of surgery can relieve postoperative hyperalgesia in patients after remifentanil -based anesthesia, with little adverse reaction.