喷他佐辛和酮咯酸氨丁三醇用于防治瑞芬太尼复合麻醉术后痛觉过敏的临床研究

Clinical research of pentazocine and ketorolac tromethamine in preventing the postoperative hyperalgesia induced by remifentanil balanced anesthesia

目的:评价喷他佐辛和酮咯酸氨丁三醇预防瑞芬太尼诱导的痛觉过敏的有效性和安全性。方法:将择期行后路腰椎体间融合术患者(PLIF)60例随机分成三组:S组于手术结束前30 min静脉滴注等剂量的生理盐水;P组于手术结束前30 min静脉滴注喷他佐辛0.5 mg/kg;A组于手术结束前30 min静脉滴注酮咯酸氨丁三醇0.5 mg/kg。记录患者的呼吸恢复时间、苏醒时间、拔管时间、手术时间及拔管后的平均动脉压和心率;对拔管后5min(T5min),10 min(T10 min),15 min(T15 min),30 min(T30 min)进行VRS疼痛评分,并记录需要镇痛的例数及术后呼吸抑制、烦躁、恶心呕吐出现的例数。结果:三组患者的呼吸恢复时间、苏醒时间、拔管时间、手术时间及拔管后的平均动脉压和心率组间比较,差异无统计学意义(P>0.05);在T 5 min时,S组的VRS评分高于A组(P<0.05),P组与S组、A组的VRS评分差异无统计学意义(P>0.05);在T10 min,T15 min,T30 min时,P组和A组的VRS评分低于S组(P<0.05),P组与A组的VRS评分差异无统计学意义(P>0.05)。三组患者镇痛例数、烦躁、恶心呕吐、呼吸抑制发生率组间比较,差异无统计学意义(P>0.05)。结论:喷他佐辛和酮咯酸氨丁三醇可有效预防瑞芬太尼复合丙泊酚麻醉腰椎术后诱导的痛觉过敏,且无明显不良反应。此外,两者抗痛觉过敏作用的比较在临床上没有意义。

Objective： To evaluate the efficacy and safety of pentazocine and ketorolac tromethamine in preventing the hyperalgesia induced by remifentanil. Methods Sixty patients undergoing posterior lumbar interbody fusion selectivesurgery were randomly assigned to be intravenously injected saline with a equal dose,pentazocine 0. 5mg / kg,ketorolac tromethamine 0. 5mg / kg,in S group,P group,A group respectively,at 30 minutes before the end of surgery. The patient＇ s respiratory recovery time,recovery time,extubation time,operation time and mean arterial pressure and heart rate after extubation were recorded.Verbal rating scales（ VRS） were assessed at 5 minutes（ T5 min）,10 minutes（ T10 min）,15 minutes（ T15 min）,30 minutes（ T30 min） respectively after extubation. The number of cases of requiring postoperative analgesia and respiratory depression,irritability,nausea and vomiting was also recored. Results： There was no statistically significant difference between three groups of patients＇ respiratory recovery time,recovery time,extubation time,operation time and mean arterial pressure and heart rate after extubation（ P〉0. 05）. At T5 minutes,the VRS score in S group was higher than that in A group（ P〈0.05） and the VRS scores comparison between P group and S group,A group respectively is not statistically significant（ P〉0. 05）. P group and A group＇ s VRS scores,indicating no statistical significance（ P〉0. 0 5） when compared,were both lower than S group＇ s（ P〈0. 05） at 10 minutes,15 minutes,30 minutes respectively after extubation. There was no statistically significant difference between three groups of patients＇ analgesia cases and theincidence of irritability,nausea and vomiting,respiratory depression（ P〉0. 05）. Conclusion： Pentazocine and ketorolac tromethamine can effectively prevent the postoperative hyperalgesia induced by remifentanil balanced with propofol anesthesia,without obvious adverse reactions. In addition,the comparison of the function anti- hyperalgesia in both did not make any sense in clinic.