瑞芬太尼不同停药方式防治痛觉过敏的临床研究

Clinical study of different drug withdrawal methods of remifentanil in the prevention and treatment of hyperalgesia

目的 观察瑞芬太尼（REM）术毕不同停药方式防治痛觉过敏（OIH）的效果。方法 选择160例ASAⅠ～Ⅱ级择期行腹腔镜妇科手术患者采用全凭静脉麻醉,根据术毕REM的用法将患者分为4组（每组40例）：LT组（立即停止REM）、JS组（减慢停止REM）、LQ组（曲马多＋立即停止REM）及JQ组（曲马多＋减慢停止REM）。分别记录4组患者呼吸恢复时间、睁眼时间、拔管时间及拔管即时的平均动脉压（MAP）和心率（HR）;并观察4组在拔管即时（T0）、拔管后10 min（T1）、30 min（T2）、1 h（T3）、2 h（T4）、4 h（T5）各时点的WHO疼痛评分,记录4组患者在术毕拔除气管导管至出PACU室的苏醒期躁动RS评分。结果 JQ、LQ两组患者的术毕呼吸恢复、睁眼及拔管时间长于LT、JS两组（P〈0.05或P〈0.01）;但拔管时血流动力学相对平稳,JQ、LQ两组的HR与MAP明显低于LT、JS两组（P〈0.01）,且JQ组低于LQ组（P〈0.01）;4组中T0～T4时点WHO疼痛评分与苏醒期躁动RS评分均有显著性差异（P〈0.01）,WHO与RS的评分均逐渐减少（JQ组〈LQ组〈JS组〈LT组）。结论 REM减速停药复合曲马多苏醒过程平稳,能有效减轻术后疼痛及苏醒期躁动,明显改善REM停药后OIH的不良影响。

Objective To observe the effect of different drug withdrawal methods of remifentanil（REM） on the prevention and treatment of hyperalgesia（OIH） after the surgery. Methods 160 patients with ASA I -Ⅱ undergoing selective la- paroscopic gynecological surgery were given total intravenous anesthesia, and they were randomly divided into 4 groups （40 in each group） according to the usage of REM after the surgery： LT group（immediately withdrawal of REM）, JS group（gradual withdrawal of REM）, LQ group（tramadol＋immediate withdrawal of REM） and JQ group （tramadol＋gradual withdrawal of REM）. Respiratory recovery time, eyes opening time, extubation time and mean arterial pressure （MAP） and heart rate （HR） at the time of extubation were recorded in the four groups of patients; immediate extubation （TO）, 10 min （T1）, 30 min （T2）, 1 h （T3）, 2 h （T4）, 4 h （W5） after extubation in the four groups were observed. The RS scores of the restlessness of the recovery period were recorded in the four groups of patients from extubation of the tracheal tube till discharge from the PACU room. Results Although the respiratory recovery time, eyes open time and extubation time were longer in JQ and LQ groups than those in LT and JS groups （P〈0.05 or P〈0.01）, but the extubation hemody- namics was relatively stable, and HR and MAP in JQ and LQ groups were significantly lower than those in LT and JS t groups （P〈0.01）, and JQ group was lower than LQ group（P〈0.01）; there were significant differences in the scores of RS and WHO scores between T0-T4 time points and restlessness in the four groups （P〈0.01）. The scores of WHO and RS were gradually decreased （JQ〈LQ〈JS〈LT）. Conclusion The awakening is steady by slow withdrawal of REM combined with tramadol, which can effectively reduce postoperative pain and restlessness during recovery period, and significantly improve the adverse effects of OIH after REM withdrawal.