盐酸氢吗啡酮用于减轻瑞芬太尼痛觉过敏的效果分析

Effect Observation on Hydromorphone Hydrochloride in Relieving Remifentanil Hyperpathia

目的观察盐酸氢吗啡酮对瑞芬太尼复合丙泊酚全麻中瑞芬太尼用量的影响及预防痛觉过敏的效果。方法整群选择2014年10月—2015年7月在该院择期全麻下行腹腔镜全子宫切除术患者56例,随机分为H组和C组（n=28）。入室给药H组为盐酸氢吗啡酮0.02 mg/kg,C组生理盐水。两组采用相同方法诱导气管插管,持续静脉泵注丙泊酚、瑞芬太尼维持麻醉,手术结束停用药。分别于静注注射液后0.5 h、1.0-3 h记录瑞芬太尼量。并记录手术结束至拔管的时间,拔管后10 min、拔管后30 min患者的VAS镇痛评分、Ramsay镇静评分等。结果在术中各时段H组瑞芬太尼用量分别为（17.21±1.641、16.50±1.575、15.46±1.835、14.43±2.150）ug/kg/min,相对C组（19.68±1.847/19.64±1.850、19.43±1.834、19.14±2.103）ug/kg/min瑞芬太尼用量H组明显减少（F〉26.167,P〈0.01）。两组患者手术结束至拔管的时间相似（P〉0.05）,拔管后10 min、30 min VAS疼痛评分H组低于C组（P〈0.05）。结论氢吗啡酮可以有效减少全麻中瑞芬太尼用量,并能有效预防瑞芬太尼引起的痛觉过敏。

Objective To observe the effect of hydromorphone hydrochloride on the remifentanil dosage in the general anesthesia of remifentanil and propofol and effect of preventing hyperpathia.Methods 56 cases of patients with selective total laparoscopic hysterectomy in general anesthesia in our hospital from October 2014 to July 2015 were selected and randomly divided into the group H and group C with 28 cases in each,the group H were treated with 0.02mg/kg hydromorphone hydrochloride,the group C were treated with normal saline,and both groups adopted the same method for inducing tracheal intubation,and they were given continuous intravenous pumping of propofol and remifentanil for maintaining anaesthesia,and stopped medication at the end of operation,and the remifentanil volume was recorded at the 0.5h and 1.0-3 h after intravenous injection,and the time from the ending of operation to extubation,VAS and Ramsay at 10 min and 30 min after extubation were recorded.Results The remifentanil dosages in each period of operation in the group H obviously decreased compared with those in the group C,[（17.21±1.641,16.50±1.575,15.46±1.835,14.43±2.150） ug/kg/min vs（19.68±1.847,19.64±1.850,19.43±1.834,19.14±2.103） ug/kg/min],（F〉26.167,P〈0.01）,the time from ending of operation to extubation of both groups was similar,P〉0.05,and the VAS at 10 min and 30 min after extubation in the group H were lower than those in the group C,P〈0.05.Conclusion Hydromorphone can effectively reduce remifentanil dosage in general anesthesia and effectively prevent hyperpathia caused by remifentanil.