超前应用舒芬太尼对瑞芬太尼术后痛觉过敏的影响

Inhibitive Effect of Sufentanil Advanced Application in Preventing Postoperative Hyperalgesia of Remifentanil in Orthopaedic Surgery

目的:比较手术切皮前和手术结束前30 min分别静脉滴注舒芬太尼0.15μg/kg,抑制瑞芬太尼全麻术后痛觉过敏的作用。方法:本研究采取双盲对照的原则,选择全麻择期下肢骨折手术60例。随机分成3组。A组:手术切皮前静注舒芬太尼0.15μg/kg。B组:手术结束前30 min静注舒芬太尼0.15μg/kg。C组(对照组):术中除瑞芬太尼外不给其它镇痛药。记录3组患者在拔管时的血压、心率、自主呼吸不吸氧状态下的血氧饱和度、拔管时间,术后10、30 min、术后2 h的VAS评分,及术后30 min躁动评分。结果:A组及B组病人术后10、30 min和术后2 h的VAS评分均低于C组。B组术后2 h的VAS评分略低于A组(P<0.05)。A组和B组病人术后30min躁动评分均低于C组,B组躁动评分略低于A组(P<0.05)。3组病人术后血压、心率、血氧饱和度及拔管时间均无显著统计学差异。结论:基于超前镇痛的原理,手术切皮前静注舒芬太尼可以有效抑制瑞芬太尼术后诱发的痛觉过敏,且术后30 min内躁动评分和术后2 h时的VAS评分手术切皮前高于手术结束前30 min给药的评分。

Objective To compare the effects of before skin incision and 30 min before the end of opera-tion intravenous injection of sulfentanil in preventing postoperative hyperalgesia after remifentanil based total in-travenous anesthesia（TIVA）.MethodsDouble-blind comparison principle was taken. Sixty patients undergo-ing lower limb fracture operations with remifentanil based TIVA were randomly assigned to 3 groups. Group A：Patients received sulfentanil 0.15 μg/kg before skin incision. Group B： Patients received sulfentanil 0.15 μg/kgat 30 min before the end of operation. Group C（control）： Patients did not receive other anesthesia except remifent-anil. The blood pressure, heart rate, oxygen saturation and extubation time were recorded at tube drawing. Thepain intensity was evaluated by vision assessment score（VAS） at the point of 10,30 min, and 2 h after surgery.The scores of patient agitation were recorded.ResultsCompared with groups A and B, VAS scores in groupC were higher at the point of 10,30 min, and 2 h after surgery. VAS scores in group B was a little less thanthose in group A at the point of 2 h after surgery（P〈0.05）. Compared with group A and B, the scores of pa-tient agitation in group C were higher at the point of 30 min after surgery. The number of patient agitation ingroup B was a little less than that in group A at thepoint of 30 min after surgery（P〈0.05）.There were nostatistically significant differences within the blood pressure, the heart rate, the oxygen saturation and the extubation time.ConclusionBased on the principle ofPreemptive analgesia, before skin incision sulfentanil can prevent postoperative hyperalgesia efficiently, thescore of patient agitation and VAS score before skin incision were a little higher than 30 min before the end ofoperation.